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Textbook of Surgery for Dental Students
Sanjay Marwah, Sham Singla
CHAPTER 1:
Introduction of Surgery
HISTORY OF SURGERY
DEALING WITH A SURGICAL PATIENT
HISTORY TAKING
History of Present Illness
EXAMINATION
General Physical Examination
Local Examination
Systemic Examination
Clinical Diagnosis
INVESTIGATIONS
Hematological Investigations
Pathological Examination
MANAGEMENT OF UNFIT PATIENT
RISK ASSESSMENT OF THE SURGERY
CHAPTER 2:
Inflammation
TYPES OF INFLAMMATION
Acute Inflammation
Chronic Inflammation
Signs of Inflammation
Acute Inflammation
Vascular Events
Cellular Events
CHEMICAL MEDIATORS OF INFLAMMATION
SYSTEMIC INFLAMMATORY RESPONSE
Endocrine Response
Metabolic Response
Immune Response
Innate Response
Acquired Response
Tumor Necrosis Factor-alpha (TNF-α)
Interleukin-1 (IL-1)
IL-6, IL-8, IL-11
IL-4, IL-10 and IL-13
Interferon-γ (IFN-γ)
Inducible Nitric Oxide Synthase (NOS-2) and Cyclooxygenase-2 (COX-2)
THE INFLAMMATORY CELLS
Neutrophils
Eosinophils
Basophils
Lymphocytes
Plasma Cells
Macrophages
Giant Cells
Foreign Body Giant Cells
Langhans' Giant Cells
Reed-Sternberg Cells
SPECIAL TYPES OF ACUTE INFLAMMATION
Outcome of Acute Inflammation
Resolution
Suppuration
Healing and Organization
Chronic Inflammation
Treatment of Acute Inflammation
CHRONIC INFLAMMATION
Pathological Features of Chronic Inflammation
Types of Chronic Inflammation
Chronic Nonspecific Inflammation
Chronic Specific Inflammation
CHAPTER 3:
Infections
DEFINITION
PATHOPHYSIOLOGY
WOUND INFECTION
BOIL (FURUNCLE)
ABSCESS
Pathophysiology
Symptoms
Signs
Treatment
ANTIBIOMA
CARBUNCLE
CELLULITIS
CELLULITIS IN SPECIAL SITES
Orbit
Neck
Clinical Features
Treatment
LYMPHANGITIS
ERYSIPELAS
BACTEREMIA
SEPTICEMIA
TOXEMIA
PYEMIA
CANCRUM ORIS
CHAPTER 4:
Specific Infections
TUBERCULOSIS
Modes of Spread
Droplet Infection
By Ingestion
Clinical Features
Pulmonary Tuberculosis
Tuberculous Lymphadenitis
Intestinal Tuberculosis
Miliary Tuberculosis
Tuberculosis of Bone and Joint
Lupus Vulgaris
Investigations
Treatment
Side Effects (Box 4.5)
Other Measures
Multiple Drug Resistance (MDR) Tuberculosis
Causes
Directly Observed Treatment (DOT) for Tuberculosis
Treatment of Cold Abscess
Surgical Treatment
SYPHILIS
Primary Syphilis
Diagnosis
Secondary Syphilis
Latent Syphilis
Tertiary Syphilis
Congenital Syphilis
Early Congenital Syphilis
Late Congenital Syphilis
Treatment
GONORRHEA
Diagnosis
Treatment
Complications
Local
Systemic
ANTHRAX
Diagnosis
Differential Diagnosis
Treatment
ACTINOMYCOSIS
Clinical Features
Facio-cervical
Thoracic
Right Iliac Fossa
Liver
Diagnosis
Treatment
TETANUS
Clinical Features
Treatment
Prophylaxis
LEPROSY (HANSEN'S DISEASE)
Classification
Clinical Features
Diagnosis
Treatment
VIRAL INFECTIONS
Precautions during Surgery in HIV Patients
Procedure in the Event of Contamination with Infected Blood
Infection of Patient by the Surgeon
CHAPTER 5:
Sinus, Ulcer and Fistula
SINUS
Anatomical Sinuses
Congenital Sinus
Acquired Sinus
FISTULA
External Fistula
Internal Fistula
Congenital Fistula
Acquired Fistula
EXAMINATION OF SINUS/FISTULA
History
Examination
General Examination
Specific Examination
Investigations
ULCER
Classification
Life History of an Ulcer
Clinical Examination of an Ulcer
History
Local Examination
Regional Examination
General Examination
Systemic Examination
Investigations
Treatment
Treatment during Stage of Transition
Treatment of Underlying Cause
CLINICAL FEATURES OF VARIOUS ULCERS
Traumatic Ulcer (Fig. 5.9)
Arterial Ulcer (Fig. 5.10)
Venous Ulcer (Fig. 5.11)
Neurogenic Ulcer
Tropical Ulcer (Phagedenic Ulcer)
Diabetic Ulcer (Fig. 5.14)
Tubercular Ulcer (Fig. 5.15)
Syphilitic Ulcer (Gummatous Ulcer)
Actinomycosis
Squamous Cell Carcinoma (Fig. 5.16)
Rodent Ulcer (Basal Cell Carcinoma) (Fig. 5.17)
Marjolin's Ulcer (Fig. 5.18)
CHAPTER 6:
Wounds
DEFINITION
Tidy Wounds
Untidy Wounds
TYPES OF WOUND (TABLE 6.2)
Abrasion, Contusion and Hematoma
Incised Wounds
Lacerated Wounds
Punctured Wounds
Avulsion Wounds
Crushed Wounds
WOUND HEALING
Phases of Wound Healing
Repair of Surface Epithelium
EXAMINATION OF WOUNDS
TREATMENT OF WOUNDS
MANAGEMENT OF FACIAL WOUNDS
MEDICOLEGAL ASPECTS OF WOUNDS
Simple Injury
Grievous Injury
Dangerous to Life
COMPLICATIONS OF WOUND HEALING
CHAPTER 7:
Surgical Asepsis and Antiseptic Measures
OPERATION THEATER DISCIPLINE
STERILIZATION
Autoclaving
Boiling
Chemical Methods
Dry Heat
Ethylene Oxide (ETO)
Formaldehyde
Gamma Irradiation
CHAPTER 8:
Hemorrhage, Blood Transfusion and Bleeding Disorders
DEPENDING UPON SOURCE OF BLEEDING
External Hemorrhage
Internal Hemorrhage
DEPENDING UPON NATURE OF BLEEDING VESSEL
Arterial Hemorrhage
Venous Hemorrhage
Capillary Hemorrhage
DEPENDING UPON TIME OF HEMORRHAGE
Primary Hemorrhage
Reactionary Hemorrhage
Secondary Hemorrhage
DEPENDING UPON VOLUME OF BLOOD LOSS
Mild Hemorrhage
Moderate Hemorrhage
Severe Hemorrhage
DEPENDING UPON SPEED OF BLOOD LOSS
Acute Hemorrhage
Chronic Hemorrhage
METHODS FOR DETERMINING THE BLOOD LOSS
TREATMENT OF HEMORRHAGE
Control of Bleeding
Pressure and Packing
Position
Rest
Operative Methods
Restoration of Blood Volume
BLOOD TRANSFUSION
Blood Collection
Blood Storage
Blood Grouping and Cross Matching
ABO Group
Rh Group
Transfusion of Blood
Autotransfusion
Complications of Blood Transfusion (Box 8.7)
Transfusion Reactions
Infections
Coagulation Failure
Congestive Heart Failure
Immunosuppression
Problems of Massive Transfusion
Fractions of Blood
BLEEDING DISORDERS
Investigations for Bleeding Disorders
Acquired Bleeding Disorders
Congenital Bleeding Disorders
Clinical features
Investigations
Treatment
Investigations
Treatment
CHAPTER 9:
Shock, Water-Electrolyte and Acid Base Balance
SHOCK
Definition
Pathophysiology
Types of Shock
Hypovolemic Shock
Neurogenic Shock
Cardiogenic Shock
Anaphylactic Shock
Septic Shock
Treatment of Shock
General Measures
Specific Measures
WATER AND ELECTROLYTE BALANCE AND IMBALANCE
Disturbances in Water Balance
Causes
Treatment
Causes
Clinical features
Treatment
Disturbances in Electrolyte Balance
Causes
Causes
Clinical features
Investigations
Treatment
Causes
Clinical features
Investigations
Treatment
Causes
Clinical features
Investigations
Treatment
Postoperative Fluid Therapy
Period of Therapy
Types of IV fluids
Contraindications
Side effects
Demerits
Indications/Uses
Contraindication
Side effects
Precautions
Dose
Uses
Contraindications
Side effects
Indications
Contraindication
ACID BASE BALANCE AND DISORDERS
Concept of pH
Acid Base Disorders
Compensation in Acid Base Disorders
Causes
Clinical features
BGA report
Treatment
Anion Gap
Causes—two types
BGA report
Clinical features
Treatment
Causes
BGA report
Treatment
Causes
Clinical features
BGA report
How to Read an Abg Report?
CHAPTER 10:
Care of the Acutely Injured
PREHOSPITAL MANAGEMENT AND FIRST AID OF TRAUMA PATIENTS
Triage
Treatment
Transport
IN HOSPITAL MANAGEMENT OF TRAUMA PATIENTS
PRIMARY SURVEY
A. Airway
B. Breathing and Ventilatory Support
C. Circulation and Hemorrhage Control
D. Disability
E. Exposure
SECONDARY SURVEY
Head and Scalp/Maxillofacial Examination
Neck and Cervical Spine Examination
Examination of Chest and Other Parts
TERTIARY SURVEY
CHAPTER 11:
Tumors
BENIGN TUMORS
Adenoma
Fibroma
Papilloma
Squamous Cell Papilloma
Basal Cell Papilloma (Senile warts, Seborrheic keratosis)
Treatment
Lipoma
Encapsulated Lipoma
Diffuse Lipoma (Fig. 11.2)
Multiple Lipomas
Complications
Treatment
Neuroma
True Neuromas
False Neuromas
Localized Neurofibroma
Generalized Neurofibromatosis (von Recklinghausen's disease)
Plexiform Neurofibromatosis
Elephantiasis Neuromatosa
Treatment of Pigmented Nevus
Other Benign Tumors in Head and Neck Region
Turban Tumor (Cylindroma)
Potato Nose (Rhinophyma)
Keratoacanthoma (Molluscum Sebaceum)
Malignant tumors
Etiology
Genetic Factors
Environmental Factors
Spread of Malignant Tumors
Staging of Malignant Tumors
Tumor Grading
Types of Malignant Tumors
Sarcoma
Basal Cell Carcinoma (Rodent ulcer)
Squamous Cell Carcinoma (Epithelioma, Epidermoid Carcinoma)
Types
Clinical Features
Spread
Treatment (Box 11.17B)
Malignant Melanoma
Site
Classification
Staging
Spread
Clinical Examination
Investigations
Treatment
Glandular Carcinoma
Lymphoma
CHAPTER 12:
Cysts and Neck Swellings
CYST
Classification of Cysts (Box 12.1)
Symptoms
Signs
Fluctuation Test
Transillumination Test
Pulsations
Complications in a Cyst
DERMOID CYST
Types of Dermoid
i. Sequestration Dermoid
Sublingual Dermoid
ii. Implantation Dermoid
iii. Teratomatous Dermoid
iv. Tubulo-embryonic Dermoid
SEBACEOUS CYST
CYSTIC SWELLINGS FROM BLOOD VESSELS
Hemangioma
Capillary Hemangioma
Venous (Cavernous) Angioma
Treatment
Arterial (Plexiform) Angioma
Cirsoid Aneurysm
Aneurysm
Etiology
Types
Clinical Features
Management
CAROTID BODY TUMOR (CHEMODECTOMA) (SOLID SWELLING)
STERNOMASTOID TUMOR (SOLID SWELLING)
CYSTIC SWELLING FROM LYMPHATICS
Lymphangioma
Complications
BRANCHIAL CYST
BRANCHIAL FISTULA
PHARYNGEAL POUCH
LARYNGOCELE
SUBHYOID BURSAL CYST
CYSTICERCOSIS
MENINGOCELE
Myelocele
ODONTOGENIC AND NON-ODONTOGENIC CYSTS
CLINICAL EXAMINATION AND DIFFERENTIAL DIAGNOSIS OF A NECK SWELLING
CHAPTER 13:
Diseases of Lymph Nodesand Lymphatics
CERVICAL LYMPH NODES
Surgical Anatomy
Clinical Examination of Lymph Nodes and Lymphatic System
History
General Physical Examination
Local Examination
Causes of Cervical Lymphadenopathy (Box 13.2)
Acute Suppurative Lymphadenitis
Chronic Nonspecific Lymphadenitis
Tuberculous Lymphadenitis
Glandular Fever (Infectious mononucleosis)
Toxoplasmosis
Cat Scratch Disease
Secondary Deposits in Lymph Nodes
Investigations
Operative Steps of Lymph Node Biopsy
Treatment
Role of Chemotherapy
Types of Neck Dissection
Radical Neck Dissection (Crile)
Modified Radical Neck Dissection
Selective Neck Dissection
Hodgkin's Lymphoma
Clinical Features
Clinical Staging (Ann Arbor staging)
Investigations
Steps
Disadvantages
Treatment
Non-Hodgkin's Lymphoma
Treatment
Burkitt's Lymphoma
Leukemia
DISEASES OF LYMPHATIC SYSTEM
Anatomy of Lymphatic System
Physiology of Lymphatic System
Acute Lymphangitis
Lymphedema
Primary Lymphedema
Secondary Lymphedema
Clinical Features of Lymphedema
Investigations
Treatment
CHAPTER 14:
Diseases of Oral Cavity
DISEASES OF THE MOUTH
Stomatitis
Aphthous Stomatitis
Monilial Stomatitis (Thrush)
Treatment:
Herpes Stomatitis
Angular Stomatitis (Angular cheilosis)
Treatment:
Ulcerative Stomatitis (Vincent's angina)
Treatment:
Gangrenous Stomatitis (cancrum oris)
Syphilis
Solitary Oral Ulcer
Cysts in the Mouth
Submucous Fibrosis
DISEASES OF THE TONGUE
Developmental Diseases
Congenital Fissuring of the Tongue
Differential diagnosis:
Tongue Tie
Lingual Thyroid
Median Rhomboid Glossitis
Macroglossia
Developmental causes:
Acquired causes:
Geographic Tongue (Glossitis migrans)
Lichen Planus
Black or Hairy Tongue
Laceration of Tongue
Inflammatory Lesions of Tongue
Ulcers of the Tongue
Aphthous Ulcer
Dental Ulcer
Postpertussis Ulcer
Tubercular Ulcer
Syphilitic Ulcer
Malignant Ulcer
Chronic Nonspecific Ulcer
DISEASES OF THE LIPS
Pigmented Lips
Cracked Lips
Macrocheilia
Chancre of the Lip
DISEASES OF THE PALATE
Palatal Perforations
Palatal Swellings
Causes of lateral swelling are:
DISEASES OF THE TONSILS
Acute Tonsillitis
Causes
Treatment
Complications
Chronic Tonsillitis
Treatment
Tonsillectomy
Indications
Steps
Complications
Peritonsillar Abscess (Quinsy)
Clinical Features
Treatment
Parapharyngeal Abscess
Retropharyngeal Abscess
Acute Retropharyngeal Abscess
Treatment:
Chronic Retropharyngeal Abscess
Treatment:
Infectious Mononucleosis (Glandular Fever)
Clinical Features
Treatment
NEOPLASTIC LESIONS OF ORAL CAVITY
Benign Neoplasms
Malignant Neoplasms
Incidence
Prognosis
Premalignant Lesions in Oral Cavity
i. Leukoplakia
Clinical features:
Treatment:
ii. Erythroplakia
iii. Chronic Hyperplastic Candidiasis
iv. Oral Submucous Fibrosis
v. Syphilitic Glossitis
vi. Sideropenic Dysphagia (Plummer-Vinson syndrome or Paterson-Kelly syndrome)
CLINICAL FEATURES OF ORAL CANCERS (BOX 14.4)
Carcinoma Tongue
Carcinoma Floor of Mouth
Carcinoma Buccal Mucosa (Cheek)
Carcinoma Gingiva and Lower Alveolar Ridge
Carcinoma Upper Alveolar Ridge, Floor of Maxillary Antrum and Hard Palate
Carcinoma Lip
Carcinoma Tonsil
INVESTIGATIONS FOR ORAL CANCERS
STAGING OF ORAL CANCERS
TREATMENT OF ORAL CANCERS
A. TREATMENT OF PRIMARY TUMOR
(i) SURGERY
(ii) RADIOTHERAPY
(iii) CHEMOTHERAPY
B. TREATMENT OF NECK NODES
i. N0 Nodes
ii. Ipsilateral Neck Nodes (N1, N2a, N2b)
iii. Bilateral Neck Nodes (N2c, N3)
Prognosis
CLINICAL EXAMINATION OF ORAL CAVITY
History
Examination
Inspection
Palpation
CHAPTER 15:
Diseases of Salivary Glands
SURGICAL ANATOMY
Parotid Gland
Submandibular Gland
Sublingual Gland
DISEASES OF SALIVARY GLANDS
Mucous Retention Cyst
Ranula
INFLAMMATORY DISORDERS
Submandibular Sialadenitis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Submandibular gland excision:
Complications
Acute Parotitis
Viral Infection
Bacterial Infection
Obstructive Causes
Granulomatous Sialadenitis
Tuberculosis
Actinomycosis
Sarcoidosis
Cat-scratch Disease
Sialadenosis
Pseudoparotomegaly
SALIVARY GLAND TUMORS
Epidemiology
Etiology
Histological Classification
PAROTID GLAND TUMORS
Pleomorphic Adenoma
Clinical Features
Warthin's Tumor
Acinic Cell Tumor
Mucoepidermoid Tumor
Adenoid Cystic Carcinoma
SUBMANDIBULAR GLAND TUMORS
MINOR SALIVARY GLAND TUMORS
Investigations for Salivary Gland Tumors
Radiological Evaluation
Cytopathological Diagnosis
Treatment of Salivary Gland Tumors
Superficial Parotidectomy (Box 15.7)
Facial Nerve Management
Management of Neck Nodes
Role of Radiotherapy
RT in Pleomorphic Adenoma: Indications
Complications of Parotidectomy
Frey's Syndrome
Sjögren's Syndrome
CLINICAL EXAMINATION OF SALIVARY GLANDS
History
Examination
Parotid Gland
Submandibular Gland
CHAPTER 16:
Diseases of the Larynx
Surgical Anatomy
Physiology
Stridor
Epiglottitis
Laryngitis
Acute Laryngitis
Chronic Laryngitis
Specific
Non-specific
Vocal Cord Polyp
Laryngocele
Vocal Cord Palsy
Etiology
Clinical Features
Investigations
Treatment
Tumors of the Larynx
Benign Tumors
Malignant Tumors
Incidence
Etiology
Classification
Staging
Investigations
Treatment
Advanced Laryngeal Tumors
Vocal Rehabilitation after Laryngectomy
Tracheostomy
Indications
Aims of Tracheostomy
Types of Tracheostomy
Surgical Anatomy
Operation
a. Emergency Tracheostomy
b. Elective Tracheostomy
Aftercare of Tracheostomy
Complications of Tracheostomy
Intraoperative Complications
Postoperative complications
CHAPTER 17:
Head Injury and Cranial Nerves Injury
Pathophysiology of head injury
Primary Injury
Secondary Injury
Mechanisms of head injury
CLASSIFICATION OF HEAD INJURY
Scalp Laceration
Skull Fractures
Brain injury
Primary Brain Injury
Secondary Brain Injury
Injury to blood vessels
A. Compartment of Bleeding
Surgical Anatomy of Intracranial Compartments
Supratentorial Hemorrhage
Infratentorial Hemorrhage
B. Plane of Bleeding
i. Extradural Hematoma (EDH)
ii. Subdural Hematoma (SDH)
a. Acute Subdural Hematoma
b. Chronic Subdural Hematoma
iii. Intracerebral and Intraventricular Hemorrhage
Management of Head Injury Patient
CRANIAL NERVES
Classification of Nerve Injuries
Seddon Classification
Neuropraxia
Axonotmesis
Neurotmesis
Examination of Cranial Nerves
Olfactory Nerve (I)
Optic Nerve (II)
Oculomotor (III), Trochlear (IV) and Abducent (VI) Nerves
Trigeminal Nerve (V)
Facial Nerve (VII)
Auditory Nerve (VIII)
Glossopharyngeal Nerve (IX)
Vagus Nerve (X)
Accessory Nerve (XI)
Hypoglossal Nerve (XII)
TRIGEMINAL NEURALGIA (TIC DOULOUREUX)
FACIAL NERVE PARALYSIS
Surgical Anatomy
Causes of Facial Nerve Paralysis
Upper motor neuron lesions
Lower motor neuron lesions
Clinical Features
Bell's Palsy
Investigations
Treatment
Medical management
Surgical management:
CHAPTER 18:
Gangrene and Diseases of Arterial System
GANGRENE
Causes of Gangrene
Clinical Features
Clinical Types
Dry gangrene
Moist gangrene
Spread of Gangrene
Treatment of Gangrene
General measures
Local treatment
Surgical treatment
Atherosclerotic Arterial Thrombosis
Surgery for Chronic Lower Limb Ischemia
Indications
Open Surgery
1. Thromboendarterectomy
2. Bypass Graft
3. Profundaplasty
Endovascular Treatment
Percutaneous Transluminal Angioplasty (PTA)
EMBOLISM
Clinical Features
BUERGER'S DISEASE
Investigations
Treatment
a. Chemical Sympathectomy
b. Surgical Sympathectomy
RAYNAUD'S DISEASE
Pathophysiology
Treatment
Complications
RAYNAUD'S SYNDROME
Treatment
CERVICAL RIB AND THORACIC OUTLET SYNDROME
Cervical Rib
Pathophysiology
Clinical Features
Investigations
Differential Diagnosis
Treatment
DRUGS CAUSING GANGRENE
Ergot Preparations
Intra-arterial Drugs
VENOUS GANGRENE
TRAUMATIC GANGRENE
A. Direct Causes
i. Crush Injury
ii. Pressure sores (Bed sores/Trophic ulcers)
B. Indirect Causes
Compartment Syndrome
Treatment
PHYSICAL GANGRENE
Frostbite
Treatment
Trench Foot
Ainhum
CHEMICAL GANGRENE
INFECTIVE GANGRENE
5. Fournier's Gangrene
6. Meleney's Gangrene (Pyoderma Gangrenosum)
DIABETIC GANGRENE
Pathophysiology
Peripheral Neuropathy
Peripheral Vascular Disease
Poor Wound Healing
Course of Events in Diabetic Foot
Examination
General Examination
Local Examination
Investigations
Treatment
CHAPTER 19:
Diseases of Venous System
VARICOSE VEINS
Primary Varicose Veins
Secondary Varicose Veins
Clinical Features
Clinical Examination
Investigations
Treatment
Operative Techniques
Trendelenburg Procedure
Stripping of Long Saphenous Vein
Stripping of Short Saphenous Vein
New Surgical Techniques
Complications of Varicose Veins
Pigmentation
Dermatitis
Lipodermatosclerosis
Thrombophlebitis
Ulceration
Treatment of Varicose Ulcer
Surgical Treatment
Marjolin's Ulcer
Hemorrhage
Calcification
Periostitis
Foot Deformity
Deep Vein Thrombosis
Clinical Features
Investigations
Treatment
CHAPTER 20:
Principles of operative Surgery, Diathermy, Radiotherapy and Anesthesia
PRINCIPLES OF OPERATIVE SURGERY
Skin Incision
Dissection
Hemostasis
Wound Closure
PRINCIPLES OF DIATHERMY
Other Energy Sources Used for Tissue Cutting and Coagulation
Lasers
Cryosurgery
High Frequency Ultrasound Waves
Harmonic Scalpel
PRINCIPLES OF RADIOTHERAPY
Delivery Systems for Radiotherapy
i. Teletherapy
ii. Brachytherapy
iii. Targeted Therapy
Radiation Dosage (Dosimetry)
Biologic Basis for Dose Fractionation
Types of Ionizing Radiations
Clinical Applications of Radiotherapy
Pretreatment Evaluation of Patient
Treatment Goals
Technical Considerations
Toxicity
PRINCIPLES OF ANESTHESIA
Introduction
GENERAL ANESTHESIA
Preanesthetic Evaluation
Preoperative Fasting
Premedication
Stages of General Anesthesia
Inhalational Anesthetics
Techniques of Inhalation of Anesthetics
Intravenous Induction Agents
Dissociative Anesthesia
Neurolept Analgesia
Airway Management
Equipment
Oral and Nasal Airways
Face Masks
Laryngeal Mask Airway (LMA)
Endotracheal Tubes (ETT)
Rigid Laryngoscope
Flexible Fiberoptic Bronchoscope
Tracheal Intubation
Position of Patient's Head
Routes of Tracheal Intubation
Neuromuscular Blockers
Analgesia
Intraoperative Analgesia
Postoperative Analgesia
Monitoring
Extubation of Trachea
LOCAL ANESTHESIA
Mechanism of Action
Pharmacological Effects of Local Anesthetics
Chemical Structure and Classification
Preparations of Local Anesthetics
Local Distribution
Clearance
Indications of Local Anesthesia in Dentistry
Advantages of Local Anesthesia
Contraindications
Technique
Local Anesthetic Agents
i. Lidocaine
ii. Bupivacaine
Complications of Local Anesthesia
Local Complications
Systemic Complications
Late Complications
Management of Overdose Reaction
CENTRAL NEURAXIAL BLOCKS
Spinal Anesthesia
Technique
CHAPTER 21:
Fractures and Maxillofacial Fractures
DEFINITIONS
Fracture
Dislocation
Subluxation
Sprain
TYPES OF BONES
Tubular Bones
Cancellous Bones
TYPES OF FRACTURES
Simple Fracture
Compound Fracture
CLASSIFICATION OF FRACTURES
Classification Based on Etiology of Fractures
Classification of Patterns of Fracture (Fig. 21.1)
HEALING OF A FRACTURE
CLINICAL FEATURES AND DIAGNOSIS
History
Examination
Radiological Examination
MANAGEMENT
First Aid
Definitive Management
General Management of the Patient
Local Management of the Fracture
Treatment of Uncomplicated Closed Fractures
Reduction
Immobilization
Rehabilitation
Treatment of Open Fractures
NEWER METHODS OF FRACTURE TREATMENT
COMPLICATIONS OF FRACTURES
FRACTURES OF HEAD AND NECK REGION
MAXILLOFACIAL FRACTURES—CLASSIFICATION
EARLY CARE
CLINICAL EXAMINATION
RADIOLOGICAL INVESTIGATIONS
For Fracture Mandible
For Fracture Maxilla
For Fracture Zygomatic Arch
For Fracture Nasal Bone
TREATMENT
General Measures
Fracture of the Zygomatic Complex
Fracture of Nasal Bones
FRACTURE OF THE MANDIBLE
Patterns of Mandible Fracture
TREATMENT OF MANDIBLE FRACTURE
I. Fracture of Tooth Bearing Segment
Closed Reduction with Indirect Fixation
Open Reduction with Internal Fixation
II. Fracture of Non-tooth Bearing Segment
Gunning Splint
III. Condylar Fracture
FRACTURE OF THE MAXILLA
Patterns of Fracture Maxilla
Le Fort I Fracture (Horizontal Fracture)
Le Fort II Fracture (Pyramidal Fracture)
Le Fort III Fracture (Craniofacial Dysjunction)
Treatment of Fracture Maxilla
ORBITAL BLOW OUT FRACTURE
COMPLICATIONS OF MAXILLOFACIAL FRACTURES
CHAPTER 22:
Cleft Lip and Cleft Palate
EMBRYOLOGY OF LIP AND PALATE
ANATOMY OF LIP AND PALATE
CLEFT LIP
CLEFT PALATE
Incidence
Etiology
Associated Anomalies
Classification
Problems
Cleft Lip
Cleft Palate
Aims of Surgical Repair
Cleft Lip
Cleft Palate
Time of Surgical Repair
Cleft Lip
Cleft Palate
Surgical Repair of Cleft Lip
Steps of Repair
Surgical Repair of Cleft Palate
Complications of Surgical Repair
CHAPTER 23:
The Thyroid Gland
SURGICAL ANATOMY
PHYSIOLOGY
HYPOTHALAMIC—PITUITARY THYROID AXIS
THYROID FUNCTION TESTS
Serum TSH, T3 and T4 Levels
Isotope Scan
Thyroid Antibodies
HYPOTHYROIDISM
Causes
Symptoms
Signs(starting from head to toe)
Investigations
Treatment
Myxoedema
GOITER
Stages in Goiter Formation
Diffuse Hyperplastic Goiter
Multinodular Goiter (MNG)
Symptoms and Signs
Complications
Investigations
Treatment
Types of Surgery
Retrosternal Goiter
THYROTOXICOSIS
I. Diffuse Toxic Goiter
II. Toxic Multinodular Goiter
III. Toxic Adenoma
IV. Rare Causes
CLINICAL FEATURES OF THYROTOXICOSIS (ANY CAUSE)
Symptoms
Signs
Specific to Graves' Disease
DIAGNOSIS FOR THYROTOXICOSIS
TREATMENT
Antithyroid Drugs (Box 23.11)
Surgery
Radioiodine
THYROID NEOPLASMS
Benign Tumors
Malignant Tumors
Etiology
Pathology
Clinical Features
DIFFERENTIATED THYROID CARCINOMA
i. Papillary Carcinoma
ii. Follicular Carcinoma
Treatment of Differentiated Thyroid Cancer
i. Papillary Carcinoma
ii. Follicular Carcinoma
Postoperative Management
ANAPLASTIC CARCINOMA
MEDULLARY CARCINOMA
MALIGNANT LYMPHOMA
SOLITARY THYROID NODULE
THYROIDITIS
Hashimoto's Thyroiditis (Chronic Autoimmune or Lymphocytic Thyroiditis)
Granulomotous Thyroiditis (Subacute or de Quervain's Thyroiditis):
Reidel's Thyroiditis
THYROIDECTOMY—OPERATIVE STEPS
COMPLICATIONS OF THYROIDECTOMY
Nerve Damage
Postoperative Bleeding
Hypocalcemia
Hypothyroidism
Thyrotoxic Crisis
Scarring and Keloid Formation
Wound Infection
Tracheomalacia
ECTOPIC THYROID
THYROGLOSSAL CYST
THYROID EYE DISEASE
(i)Stelwag's Sign
(ii) Von Graefes' Sign
(iii) Joffroy's Sign
(iv) Moebius Sign
Treatment
CLINICAL EXAMINATION OF THYROID GLAND
History
General Physical Examination
Local Examination of Neck
CHAPTER 24:
The Parathyroid and Pituitary Gland
SURGICAL ANATOMY
PHYSIOLOGY
HYPOPARATHYROIDISM
Clinical Features
Diagnosis
Treatment
HYPERPARATHYROIDISM
Primary Hyperparathyroidism
Secondary Hyperparathyroidism
Tertiary Hyperparathyroidism
Clinical Features
Diagnosis
Biochemical Investigations
Radiological Investigations
Differential Diagnosis
Treatment
HYPERCALCEMIA
Pathophysiology
Etiology
Clinical Features
Treatment
FUNCTIONS OF PITUITARY HORMONES
Hormones of Anterior Pituitary
Hormones of Posterior Pituitary
DISEASES OF PITUITARY GLAND
Hyperpituitarism
Hyperfunction of Anterior Pituitary
Hyperfunction of Posterior Pituitary and Hypothalamus
Hypopituitarism
Hypofunction of Anterior Pituitary
Hypofunction of Posterior Pituitary and Hypothalamus
Pituitary Tumors
Clinical Features
Investigations
Treatment
CHAPTER 25:
Swellings of the Jaw
I. EPULIS
1. Fibrous Epulis
2. Granulomatous Epulis (False Epulis)
3. Pregnancy Epulis
4. Giant Cell Epulis (Myeloid Epulis)
5. Carcinomatous Epulis
II. ODONTOMES
1. Dental Cyst (Radicular Cyst, Periodontal Cyst)
2. Dentigerous Cyst (Follicular Cyst)
3. Adamantinoma (Ameloblastoma)
4. Odontogenic Keratocyst
Mesothelial Odontomes
i. Nasolabial Cyst
ii. Nasopalatine Cyst
iii. Median Cyst
iv. Globulomaxillary Cyst
v. Solitary Bone Cyst (Hemorrhagic or Aneurysmal Bone Cyst)
III. SWELLINGS CAUSED BY JAW TUMORS
A. Osseous Jaw Tumors
1. Benign Osseous Tumors
2. Malignant Osseous Tumors
B. Non-osseous Jaw Tumors
1. Benign Non-osseous Tumors
2. Malignant Non-osseous Tumors
Metastatic Deposits
Multiple Myeloma
Histiocytosis X
IV. INFLAMMATORY SWELLINGS
Pericoronitis
Treatment
Complications of Alveolar Abscess
Chronic Dental Sinus
Clinical Features
Treatment
Osteomyelitis of the Jaws
Classification
CLINICAL EXAMINATION OF THE JAWS
Examination of Maxilla
Examination of the Mandible
CHAPTER 26:
Imaging Techniques for Head and Neck Lesions
CONVENTIONAL RADIOGRAPHY
Patient Positioning
ULTRASONOGRAPHY
Principle
Doppler Ultrasound
Terminologies
Advantages of Ultrasound
Drawback of Ultrasound
ULTRASOUND FOR HEAD AND NECK LESIONS
CT SCAN
Principle
Spiral (Helical) CT
Multislice or Multidetector Spiral CT
Reading a CT Film
Advantages of CT Scan
Drawbacks of CT Scan
CT SCAN FOR HEAD AND NECK LESIONS
Head and Neck Tumors
Traumatic Injuries
Inflammatory Lesions
Cervical Adenopathy and Neck Masses
a. Nodal Neck Masses
b. Non-nodal Neck Masses
Masses Arising from Aerodigestive Tract
Thyroid and Parathyroid Glands
MAGNETIC RESONANCE IMAGING (MRI)
Principle
T1 and T2 Weighted Images
Radiofrequency Sequences
Contrast Agents
MRI vs CT SCAN
Advantages of MRI
Drawbacks of MRI
MRI for Head and Neck Lesions
INTERVENTIONAL RADIOLOGY
Vascular
Non-vascular
RADIONUCLIDE STUDIES
PET Scan
SPECT
CHAPTER 27:
Burns and Skin Grafting
BURNS
Definition
Etiology
Degrees of Burns
Clinically
Healing
Management of Burns
First Aid Measures
Emergency Management
Early Treatment
Monitoring
Local Treatment
Surgical Treatment
Nutrition
SKIN GRAFTING
Donor Site
Recipient Site
Methods of Grafting
a. Grafting
b. Flap
i. Split Thickness Graft (STG)
ii. Full Thickness Graft
Causes of Graft Loss
Mesh Graft
Stamp Graft
Pedicle Skin Flap
CHAPTER 28:
Surgical Suturing
SURGICAL NEEDLES
Parts of a Needle
Classification
On the Basis of its Eye
On the Basis of its Shape
On the Basis of its Edge
SUTURE MATERIALS
Classification
Size of Sutures
Principles for Selecting Sutures
Characteristics of Ideal Suture Material
SUTURING TECHNIQUES
Types of Surgical Knots
Reef Knot
Granny Knot
Surgeon's Knot
CHAPTER 29:
Surgical Instruments
INSTRUMENTS USED FOR CLEANING AND DRAPING
Cheatle's Forceps (Fig. 29.1)
Rampley's Sponge Holding Forceps (Fig. 29.2)
Mayo's Towel Clip (Fig. 29.3)
Moynihan's Tetra-towel Clip (Fig. 29.4)
DISSECTING FORCEPS
Toothed Forceps (Fig. 29.5)
Non-toothed or Plain Forceps (Fig. 29.6)
TISSUE HOLDING FORCEPS
Allis Tissue Forceps(Fig. 29.7)
Babcock's Tissue Forceps (Fig. 29.8)
Lane's Tissue Forceps (Fig. 29.9)
Tongue Forceps (Fig. 29.10)
FORCEPS USED FOR HEMOSTASIS
Artery Forceps (Hemostat)
Small or Mosquito Forceps (Fig. 29.11)
Medium Artery Forceps
Large Artery Forceps
Kocher's Forceps (Fig. 29.16)
Pott's Bulldog Clamp (Fig. 29.17)
Well's Arterial Clamp (Fig. 29.18)
SUTURING INSTRUMENTS
Surgical Needles
Aneurysm Needle (Fig. 29.19)
Needle Holder (Fig. 29.20)
Clip Applicator (Michel's)
Clips Extractor
INSTRUMENTS USED FOR MAKING INCISION
Bard Parker Knife Handle
Detachable Blades
SCISSORS
Straight Scissors
Curved Scissors (Fig. 29.25)
RETRACTORS
Nerve Hook/Retractor (Fig. 29.26)
Skin Hook (Fig. 29.27)
Cat's Paw Retractor (Fig. 29.28)
Kocher's Thyroid Retractor (Fig. 29.29)
Joll's Thyroid Retractor (Fig. 29.30)
Doyen's Mouth Gag (Fig. 29.31)
Langenbeck's Retractor (Fig. 29.32)
Czyerny's Retractor (Fig. 29.33)
Morris Retractor (Fig. 29.34)
Deaver's Retractor (Fig. 29.35)
Doyen's Retractor (Fig. 29.36)
Self-retaining Abdominal Wound Retractor (Fig. 29.37)
MISCELLANEOUS INSTRUMENTS
Trocar and Cannula (Fig. 29.38)
Hudson's Brace and the Burr (Fig. 29.39)
Periosteal Elevator (Fig. 29.40)
Gigli Saw (Fig. 29.41)
Bone Nibbler (Fig. 29.42)
Malleable Probe (Fig. 29.43)
Probe with Dissector (Fig. 29.44)
Brodie's Fistula Director (Fig. 29.45)
Kocher's Thyroid Dissector (Fig. 29.46)
Volkmann's Scoop (Curette) (Fig. 29.47)
Humby Skin Grafting Knife (Fig. 29.48)
Myer's Vein Stripper (Fig. 29.49)
TRACHEOSTOMY INSTRUMENTS
Cricoid Hook (Fig. 29.50)
Tracheal Dilator (Fig. 29.51)
Tracheostomy Tubes
Metallic Tube (Fig. 29.52)
Plastic Tubes
DRAINS
Types of Drain
Corrugated Drain (Fig. 29.54)
Tube Drain
General Principles for Putting a Drain
PLASTIC AND RUBBER INSTRUMENTS
Ryle's Tube (Fig. 29.57)
Uses of Ryle's Tube
How to Pass a Ryle's Tube?
Infant Feeding Tube (Fig. 29.58)
Venesection Cannula (Fig. 29.59A)
Indications of Venous Cut Down
How to do Venesection? (Fig. 29.59B)
Urethral Catheters
Types
How to do Urethral Catheterization?
Technique of Catheterization
Complications of Catheterization
Malecot's Catheter (Fig. 29.64)
CHAPTER 30:
Wound Dressings and Bandages
DRESSING
Parts of a Dressing
Contact Layer
Intermediate Layer
Outer Layer
BANDAGES
Bandaging for Head and Neck Region
Head Bandage
Eye Bandage
Ear Bandage
Bandage for Lower Jaw
Neck Bandage
Bandage for Fracture Clavicle
CHAPTER 31:
Surgical Specimens
PATHOLOGICAL SPECIMENS OF HEAD AND NECK
Tuberculous Lymphadenitis
Lymphoma
Multinodular Goiter
Squamous Cell Carcinoma of Mandible
Osteosarcoma of Mandible
Pleomorphic Adenoma
Lipoma
Cystic Hygroma
INDEX
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