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Plastic surgery is a very wide field and has its application in rather every surgical speciality. This speciality is concerned with correction of externally apparent deformities and functional deficits. Ancient Indian Plastic surgeon Sushrut (Father of Plastic Surgery) was famous for performing various reconstructive procedures especially of nose and ear. Purpose of plastic surgery is to restore the individual to normal whereas cosmetic surgery is an attempt to surpass the a€?normala€™ e.g. Most important role of plastic surgery is in injuries involving skin, muscle, tendons, nerves, vessels, facial bones. Face is our most important means of identity and interaction in society; also it houses all the five sense organs of body. Management of wounds especially facial and hand is no longer governed by rule of 6 hours though earlier the repair better it is.
Over the past years there has been tremendous change in management of facial bone fractures.
Skin lacerations: All lacerations of face should be treated by using plastic surgery techniques so as to get better cosmetic and functional results and early recovery. Jaw bone fractures (upper as well as lower) are associated with malocclusion loss of appropriate relationship between upper & lower teeth.
Nasal bone fracture is the cause of bleeding from nose and depression or deviation of the nose.
These fractures tend to get sticky by tenth day so ita€™s always better to start treatment as early as possible.
Forehead fracture usually involves underlying sinus and must be treated in time otherwise this may in future be a cause of osteomyelitis (infection of bone).
Firearm or blast injuries: These injuries are always associated with extensive tissue loss (soft tissue as well as bony) and wound contamination. Clefts: Cleft lip & palate is one of the most common congenital anomaly with incidence of about one in every 600 child. Congenital nevi (black spots): Small spots may be removed in single stage with local skin flaps but method of tissue expansion is better for larger lesions.
Two important things needed for total ear reconstruction are ear framework that is covered by skin on both sides. Ear Framework- Ear a€?frameworka€? may be made from patienta€™s own rib cartilage (preferable) or commercially available silicon or porex implant. Skin Cover- Skin on mastoid bone area ie behind the actual site of ear, is used for the cover. Congenital deformities: Syndactyly, polydactyly, absence of thumb, contractures, constriction rings, cleft hand, macrodactyly, hypoplasia etc.
Age for surgery: As far as possible all major surgical reconstructions should be complete before school going age so that maximum possible function can be achieved during development period.
In fingertip injuries nail bed is usually damaged and if left unrepaired it may cause tender scar or odd looking non-adherent nail.
Severity of hand injury may vary from a simple skin laceration to loss of a major part or whole hand. In finger tip injuries nail bed is usually damaged and if left unrepaired it may cause tender scar or odd looking non-adherent nail. Incised or lacerated wounds on wrist or forearm are associated with tendon or neuro-vascular injuries. Reimplantation surgery: Amputated part should be cleaned, wrapped in moist saline gauge and put in a dry polythene bag.
Apart from artery and vein our circulatory system consists of lymphatic vessels that run approximately parallel to blood vessels in superficial plane.
Water along with certain nutrients, O2 and small amounts of plasma proteins are continuously filtered away from arterial capillaries in tissues and substances to be excreted are similarly taken back by venous capillaries. Trend now a days is of management of deep burn injuries by early excision of burn wound and skin grafting wherever possible. At times people are dissatisfied from their looks or body shape that may be changed by means of cosmetic surgery. Rhinoplasty (change in shape of nose): For broad, depressed, deviated nose, parrot beak shaped nose, acquired defects or other unsightly problems. Genioplasty (change in shape, size of chin): For disproportionately protruding or recessed chin. Facelift, browlift and necklift: For aging face a€” to correct wrinkles & sagging skin of face, neck and sagging eyebrows.
Breast augmentation a€” For underdeveloped and small breasts that may be a cause of lack of self-confidence and depression. Brest reduction a€” For hyperplastic, large, ptotic breasts, which not only look awkward, but are also a cause of shoulder, neck and back-ache. Breast reconstruction a€” Ita€™s needed in patients of breast cancer whose disease has been cured or in some girls with congenital absence or hypoplastic breast.
Gummy smile (exposure of gums while smiling): In few persons upper teeth and gums are excessively visible while smiling. Congenital black spots (nevus), moles: Excision of small nevi or moles is an outdoor procedure. Scar revision: Revision of most of the facial scars is an outdoor procedure and hospitalisation is usually not needed. Baldness: Surgical options for correction of baldness are hair grafting, scalp flaps or tissue expansion.
Lipofilling: This is used for cheek or lip augmentation or correction of facial asymmetries by fat injections.
Gynecomastia (Breast enlargement in males) : Liposuction is the best way to manage this problem if there is no glandular tissue.
Plastic Surgery is basically reconstructive surgery and covers almost every external organ of the body. Benign positional vertigo (BPV) is a relatively common condition which is characterized by episodes of severe spinning (vertigo) associated with turning the head. The treatment for this type of dizziness is a physical maneuver which can easily be done in the office.
The balance system in the ear is called the vestibular system and it consists of the semicircular canals which have the nerve endings of the nerve of balance. Meniere's Disease (MD) is characterized by hearing loss, ringing in the ear, and episodes of severe dizziness often with nausea and vomiting. Treatment of MD is directed primarily at controlling the episodes of dizziness which can be debilitating. Treatment includes antibiotics to treat the infection and in some cases allergy treatment to reduce Eustachian Tube swelling and help with drainage. In some cases the bacteria can be eliminated but the fluid remains causing a persistent hearing loss.
In some situations the acute infection may resolve, but continue to recur despite medical therapy. In some cases these infections are recurrent or chronic and require other treatments and medications.
The medical diagnosis of 'SUDDEN HEARING LOSS' is a hearing loss due to inflammation of the nerve of hearing (viral infection is the most accepted theory). During diving and flight elevation or landing, the pressure is changing To adapt to it, pressure of middle ear should be changed accordingly by opening up the eustachian tube. Pure tone audiogram is necessary as it usually shows conductive hearing loss.  However if inner ear is involved, sensorineural hearing loss may be seen. For blood or fluid in the middle ear, observation is suggested.  But it can be drained by myringotomy if it is not subsided after a period of time. If there is inner ear injury, conservative management such as bed rest and drugs is recommended.  But if hearing deteriorates progressively, surgical exploration and operation would be suggested. Acute otitis media is acute infection of the middle ear which is either due to viral or bacterial infection. After AOM, some fluid may accumulate in the middle ear resulting in conductive hearing loss. While the majority of eardrum perforation heals spontaneously, some perforations persist due to unresolved infection or Eustachian tube dysfunction. Normally the middle ear and external ear canal is separated by the thin membrane called tympanic membrane or ear drum. It is different from the usual CSOM (chronic suppurative otitis media) that skin "grows" inside the middle ear and mastoid process and forms a "tumour-like" plague. It is usually presented as sudden onset of sustained vertigo and dys-equilibrium accompanied by a spontaneous wobbling of eyeballs lasting from 3 to 7 days followed by gradual resolution.
Basically it only needs supportive treatment with relief of dizziness during the acute episode.
The patient with BPPV (Benign Paroxysmal Positional Vertigo) experiences severe spinning associated with a change of head position.


A test called Dix-Hallipike maneuver is done for eliciting nystamus (wobbling of eyeballs) and vertigo caused by posterior canal BPPV. In general, the theory of canalithiasis, which is well accepted as the explanation of BPPV (Benign Paroxysmal Positional Vertigo)? It is a condition where a benign tumor is arising from the eighth cranial nerve which is called vestibulocochlear nerve (mostly involves the vestibular nerve rather than the cochlear nerve). The classic presentation of acoustic neuroma would be unilateral progressive sensorineural hearing loss. We can either treat it with hearing aids or operative treatment which is called stapedectomy.
Systemic steroid is the evidence based treatment of choice as it can suppress the inflammation caused by the viral infection.
The majority of nose bleeds occur in the front of the nose called the septum and turbinates. Nose bleeds are more common in extreme weather conditions and during rapid weather changes especially when the air gets both colder and drier quickly.
Lean forward, open the mouth to breathe and apply firm pressure to the soft lower third of the nose (essentially squeeze the bottom half of the nose together so you cannot breathe through the nose at all). By tipping your head forward and down by at least 20 degrees, blood will not run back down to the throat and make you cough and splutter. Hold this for 20 minutes (normal blood will coagulate after 5 minutes and holding longer gives it a margin of security).
If you are taking blood-thinning drugs like Warfarin, Aspirin, Plavix, Pradaxa, etc., you will need to continue pressing for longer.
If the bleeding persists, especially down the back of the throat, then the bleeding area is most likely at the back of the nose. After the bleeding has been arrested, an endoscopic nasal inspection would be advised especially if this has been a recurrent event.
Readers should consult their physician before considering treatment, and should not interpret their condition solely based on the information above. Come in for a free hearing evaluation and receive a FREEcaption call phone (restrictions apply). ENTs (ear, nose, and throat specialists) and audiologists are both qualified to remove ear wax in their office.
Your doctor may also use water to irrigate the ears as well as stronger medicinal solutions to break up the ear wax. If your audiologists feels that the buildup can be removed at home, he will either instruct you to buy a kit or send you home with one. Whether you need to stay at the audiologist’s office to have your ear wax removed or he sends you home with a kit, it's a relief to know that professionals know what they are doing and can help you get relief from ear wax buildup. Study conducted by UCLA Sleep Disorder Center concludes impact to brain function from sleep apnea.
When checked, Shutterstock's safe search screens restricted content and excludes it from your search results. The word a€?plastic surgerya€? has been taken from Greek word a€?Plastikosa€? meaning a€?fit for mouldinga€?.
Reconstruction of damaged or lost structures is better done by principles & techniques of plastic surgery. Healing by primary intention means that after injury, wound is repaired by surgical means so as to close the gap between damaged tissue margins.
Goal of management is not only restoration of appearance but also of function, which is so much important for day to day activities. Suturing of simple facial wounds is not a job to be done in outdoor clinics with relatives holding a crying child and doctor putting stitches with local or even only vocal anesthesia. At times in badly contaminated wounds, repair may need a stage of debridement before final skin cover. CT scan especially 3D CT gives a very good view of facial skeleton and is the best tool to map out bony injuries.
In cases of congenital absence of ear {microtia} there is also atresia of external auditory canal. In many situations injured person is the sole earning member of the family and any such incapacitating injury may deprive the family of its livelihood. In case of fingertip amputations every effort is made to restore or at least preserve the remaining finger length that is so much necessary for optimum hand functioning. Plasma proteins and other large molecules that cana€™t be taken back by venous capillaries, seek its way through lymphatics. It may be apparent in early childhood, after puberty or even in adulthood depending on severity of blockage.
The superficial burns almost always (unless infected) heal without any significant scarring in two to three weeks time. However in case of large scars which cana€™t be removed under local anesthesia, hospitalisation for a day may be needed.
Small facial spots may be excised and defect repaired by suitable plastic surgery procedure. Fat is retrieved by liposuction and is injected in desired areas under strict aseptic and anaerobic conditions. Calcium crystals floating in the inner ear fluid stimulate the nerve of balance and stimulate dizziness. In some cases the pattern of symptoms suggests a specific cause and this provides a starting point for the evaluation. MD is a chronic condition which is managed like other chronic conditions such as asthma or arthritis.
People can have one episode every few years or frequent episodes several times a week or month. Bacterial or viral infection sometimes in association with allergy leads to an accumulation of fluid in the middle ear space behind the ear drum (see ear diagram). In these cases the fluid is drained by placing a ventilation tube (or pressure equalization tube, PE tube) through the ear drum with a brief surgical procedure. This is an emergency requiring immediate treatment in order to maximize the chance of regaining hearing.
The dizziness can be controlled with medications until the virus has passed through the system. For otitis externa (ear canal infection), ear toilet, topical antibiotic eardrops with or without oral antibiotic is the standard treatment. Except paediatric cases with bilateral OME and hearing impairment, we may observe for any resolution of OME with time. The most frequently cited occurrence of this symptom follows rolling over in bed or getting into bed and assuming a lying-on-back position.
When we turn or move our head or change our positions, the stone-like substances in the ampulla ( the organ for sense of balance)moves and irritate the said organ. Normally, the lesions are removed by excision and the specimen is then checked by pathologist. In this case, an Ear, Nose & Throat Specialist or hospital care should be sought immediately, as the bleeding is less likely to be controlled by your own applied pressure in the front, and may recur later. Most people have a normal amount of ear wax, and the ear wax drains out of the ears by itself. Some people are able to remove excess ear wax at home with kits or products that can be found at most drug stores.
ENTs are probably the more common choice for ear wax removal appointments, but some patients already have an audiologist that they trust and therefore decide to go and visit them instead of going to a new doctor.
They prefer to send patients home with an ear wax removal kit, but will do an in-office procedure if needed.
Know that if you feel most comfortable seeing an audiologist to remove ear wax, he will be fully capable of doing so. Together with this process, skin cells from the periphery of wound margin migrate toward center of wound to cover the granulation tissue. In cases of polytrauma priority of management depends on general condition of patient and other associated injuries. Correction of lacerations may be simple straight line closure or may need some plastic surgery procedure like Z a€“ plasty, W a€“ plasty etc so as to give final scar line parallel to skin creases. Open reduction and fixation of facial bones by miniplates and screws obviates the need of keeping mouth closed by inter maxillary fixation in majority of cases.
Reimplantation of avulsed scalp skin is possible in selected cases and hence it should be preserved (as described in Microsurgery- reimplantation surgery) and brought to hospital with patient as early as possible. These children may have problem in binaural hearing and in recognition of direction of sound {if deficiency in hearing is more than 15 decibel}.
Goal of treatment should be restoration of a functional hand in least possible time and not just wound healing. Most often these types of injuries are caused by door hinges and children are the usual victims.


Single stage repair is possible in distal penile or selected cases of mid penile varieties. Main role of these is to carry away proteins and other substances that cana€™t be reabsorbed in venous capillaries. Deep burns need specialised management so as to avoid the menace of fibrosis, scarring, disfigurement and joint contractures.
We should remember that a€?once scar, always scar; ita€™s quality can definitely be improveda€?. Besides removal of excess fat and loose sagging skin, abdominal muscles are tightened also so as to restore their tone.
This triggers both the nerve of hearing and the nerve of balance leading to the typical symptoms. There are medications or treatments taken on a regular maintenance basis and there are other medications or treatments for acute flare ups. Normally this fluid would drain through the Eustachian Tube into the nose but with an infection the drainage tube may be blocked. Placement of a ventilation tube creates an alternative pathway and helps control the infections. If that hole is plugged by water or shifting wax, the patient experiences a 'sudden hearing loss'. The noises range from infrequent and inconsequential to continuous and disruptive during the day and night. But that is alright as long as the cause has been sought for, and importantcauses excluded. Bleeding from the back of the nose also tends to be more profuse as the bleeding points are nearer the feeding arteries with a higher pressure. Your audiologist will assess the seriousness of the ear wax buildup before deciding what actions to take.
A currette is a small device with a scoop at the end that is used to gently scoop the ear wax out of the ear canal. Sometimes he will try one method first, or a combination of the methods to achieve results. The solution works to soften up the ear wax, and the bulb syringe is used to gently flush out the ear wax with water. Both types of procedures are performed by same surgeon and basic principles are also the same. Nasal bones, mandible and zygoma are the most commonly affected bones followed by maxilla and frontal bones in decreasing order of incidence. Scarring depends on many factors such as magnitude of trauma, type of wound, type of skin, age of patient, genetic predisposition of person for scaring etc.
If laceration is repaired by ordinary suturing there may develop cross hatch marks of sutures as shown in photo. However any scar at the site of external auditory meatus may have its adverse impact on reconstructive ear surgery hence no surgery should be done for meatus or atretic canal before ear reconstruction. Seemingly minor looking lacerations may have underlying tendon, vascular or nerve injuries.
In case of finger amputations every effort is made to restore or at least preserve the remaining finger length that is so much necessary for optimum hand functioning. With the help of microsurgery we can not only do reimplantation but also we can transfer certain body tissues (free flap) along with their blood and nerve supply (optional) to other parts of the body according to requirement.
This may be congenital (absence of development or insufficiency) or acquired due to trauma, burn, infection, malignancy, radiotherapy etc. One of the main aims of cosmetic surgery is to restore the mental health of the person thus permitting return to social participation. The sense of balance is also affected by vision, special sensory nerves in the muscles and joints, blood pressure and circulation, and some hormones in the blood. In some instances the heart, blood vessels, and brain may also need evaluation by the appropriate specialists. If pressure builds up in the middle ear because of Eustachian tube dysfunction or infected fluid that can also cause a 'sudden hearing loss'. The vestibular system is based on symmetry; the input from each nerve of balance has to be coordinated with the other.
In this case, it becomes necessary to visit the doctor and have the ear wax professionally removed.
Plastic surgeons are better trained for management of skin, nerve, vascular, tendon and muscle injuries. Restoration of facial bony framework is always given priority over treatment of facial wounds. In second stage this framework covered with skin, is elevated from the site where it was implanted and the defect (thus created a€“ on posterior aspect of reconstructed ear and the site from where the framework has been elevated) is covered with split skin graft. This is more so important in cases of multiple finger tip amputations, commonly seen in factory workers. Substances that cana€™t be taken back because of this blockage or insufficiency, get pooled up in subcutaneous tissues and lead to swelling. Now days ita€™s done with special syringes (tumescent liposculpture technique) that offers better results with negligible complication rate. When one nerve has a viral inflammation it begins to send signals to the brain out of sync with the other ear.
Plastic surgery is basically reconstructive surgery that may be related to any part of body from head to toe; be it loss of scalp, cranium, facial fracture, hand injuries, avulsion injuries or compound fractures. They must have patience and must realize that treatment is not like magic and recovery and scar maturation take time.
Facial scars can be managed at a later date but ita€™s difficult to treat a malunited fracture. Crush injuries (combined soft tissue and bony injuries) are best managed by a team of plastic surgeon & orthopaedician. Lymph nodes are clustered in certain parts of the body in the path of lymphatics and act as filter for lymph.
Ita€™s rich in plasma protein that forms coagulum, may act as substrate for thriving of bacteria and itself may lead to chronic tissue inflammation. These signals tell the brain you are moving when you are not actually moving, resulting in the sensation of spinning known as vertigo. Injuries may be in form of abrasions, lacerations, contusions, incised wounds, maxillofacial fractures, partial or total loss of parts of face (nose, ear, lip, eyelid) or burns. Management in such cases is wound debridement, skeletal fixation followed by skin cover as early as possible.
Person gets repeated infections due to increased susceptibility that further accelerates lymphatic blockage and it may become a vicious cycle. Deep lacerations may be associated with facial nerve, salivary duct or even salivary gland injury. In cases of complete clefts (cleft lip & palate) lip, alveolus and part of hard palate is repaired in first stage (after age of ten weeks). Avulsion injuries are best managed by wound debridement and provision of skin cover as early as possible.
Surgical repair of cleft lip and anterior part of palate is done at about 3 months of age provided childa€™s weight is appropriate to its age. In most of the cases of avulsion and crush injuries ita€™s possible to provide skin cover in 3 a€“ 5 days.
Delay in provision of skin cover increases the chances of infection, fibrosis, scarring leading ultimately to restriction of joint movement and poor results. Orthopaedician does the skeletal fixation and plastic surgeon does wound debridement and provides skin cover. Gone are the days when these injuries were treated by dressings and dressingsa€¦ till granulation tissue was fit to accept skin graft. In most of the cases ita€™s now possible to provide skin cover with in a week after injury, which not only improves results but also saves time and ultimately money of the patient.
With proper management and follow up till the age of about 15 years child can attain normal facial development Absence, hypoplasia or other deformities of nose, eyelids or other parts.
Delay in provision of skin cover increases the chances of infection, fibrosis, scarring leading ultimately to restriction of joint movement. Once the skin cover has matured, next step is surgery for tendon or nerve repair or even tendon transfer in selected cases.



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Comments to «Tinnitus ear bleeding ulcer»

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