Textbook of Surgery for Dental Students Sanjay Marwah
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abbe flap 150, 150f
Abdomen 6, 81, 231
Abdominal groans 289, 290
Abdominal wall 84
hematoma 48f
wound, infected 53f
Abdominal wound retractor, self-retaining 342, 342f
Abducent nerve paralysis 190
ABO group 65
Abrasion 47, 48
thigh 48f
Abscess 11, 15, 17, 18, 214
anatomical areas of 17
axilla 17f
cheek 16f
communicating 18
discharging sulfur granules 30
drainage of 17, 236
leading septicemia 15
lip 16f
nail bed 16f
progress of 16fc
Absorbable sutures, properties of 329t
Acid
burn, treatment of 312fc
fast bacilli 33, 40
Acid-base imbalance 67
Acinic cell
carcinoma 161
tumor 163
Acoustic neuroma 87, 193
Acquired immunodeficiency syndrome 14, 27, 66, 135
Actinomyces israelii 30
Actinomycosis 13, 23, 30, 3741, 45, 160, 292, 304
head and neck of 30
Adamantinoma 104, 297, 294, 298
Addison's disease 139
Adenocarcinoma 100, 179, 161, 300, 301
Adenoid
curettage of 178f
cystic carcinoma 161, 163
enlarged 178
hypertrophy 178
tissue 122
Adenoidectomy 178
Adenolymphoma 168
Adenoma 83, 161, 279, 291, 300
thyroid isthmus 121
Adequate analgesia 222
Adequate hydration 222
Adhesive surface 358f
Adipose tissue 300
Adiposis dolorosa 85
Adrenal insufficiency 290
Adrenaline containing local anesthesia, intra-arterial injection of 210
Adrenergic blockers 206
Adson's deep breathing test 208
Air embolism 66, 73
Airway 76, 314
assessment 77t
compromise 82
management of 77t, 232
obstruction 141
surgical 234
Albright's syndrome 296, 296b
Alcohol 59, 60, 144
Aldehydes 59, 60
Alkali 40
burns, treatment of 312fc
Allergic
conditions 11
reactions 66
Allergy 81
Allis tissue forceps 335, 335f
Alopecia 231
Alpha particles 230
Alveolar abscess 32, 292
complications of 302
spread of 304
Alveolar mucosa 6
Alveolar ridge
carcinoma upper 147
lower 147
Alveolectomy 236
Alveoloplasty 236
Alveolus, upper 150
Amelanotic melanoma 99
Ameloblastoma 292, 294, 294b, 295f
American College of Surgeons' Committee on Trauma 76
American Society of Anesthesiologists 231, 231t
Amikacin 25, 27
Aminoamides 235
Aminoesters 235
Aminophylline 73
Amiodarone 271
Amnesia 186, 232
period of post-traumatic 186
Amoxicillin 18, 19, 125
Amphotericin B lozenges 135
Ampicillin 171
Amputation 197, 205, 206, 214
Amyloidosis 138
Anal canal 39
Analgesia 232, 235, 315
Analgesics drugs 142
Anaphylactic reaction 218
Anaphylactic shock 70, 73
Anaphylatoxins 9
Anaphylaxis 201
Anaplastic carcinoma 274, 277
thyroid 278b, 278f
Anemia 5, 52, 123, 129, 196, 209, 301
aplastic 135, 231
Anesthesia 204, 255
advantages of local 236
complications of local 237
control of 2
day care 231
infiltration 237
local 19, 53f, 235
maintenance of 232
principles of 231
regional 237
risk of 149
surface 237
Anesthetic agents, local 236
Aneurysm 103, 104, 111
false 111
needle 338f
Aneurysmal bone cyst 296, 296f
Angina 214
Angiofibroma 172, 178
Angiography 201, 205
complications of 201b
Angioma 162
Angioneurotic edema 139
Angiopathy 195
Angioplasty, laser-assisted 227
Angiosarcoma 300
Angular cheilosis 136
Angular dermoid
external 105f
internal 105f
Angular stomatitis 136, 137f, 139
Aniline dyes 59, 60
Ankle
brachial pressure index 44
jerk 266
Ankyloglossia 146, 146f, 153
Ann Arbor staging 129
Anorexia 40
Anosmia 231
Antacids 290
Anterograde amnesia 187
Anthrax 29, 30, 30t
Antiarrhythmic drug 271
Antibioma 17, 17f
Antibiotic 7, 20, 171, 196, 212, 315
therapy 19
Anticholinergic agents 235
Anticoagulant drugs 67
Antidepressants 161
Antiemetics 232
Antigas gangrene serum 212
Antihistaminics 171
Antipyretic drugs 142
Antiseptic measures 57
Antithyroid
antibodies 281
drugs 266, 272, 273, 273t
blocking synthesis 263t
Antitubercular drugs 25
side effects of 26t
Antitubercular treatment 43
Antrochoanal polyp 178
Anxiety 167, 285
neurosis 32
relief of 232
Aorta
abdominal 199
arch of 199
Aortic aneurysm 172
Aortic body receptors 112
Aortofemoral bypass graft 203, 203f
Aortoiliac disease 198, 203
Aphthous stomatitis 135, 139
Aphthous ulcer 136, 136f, 139
Aplasia 132
Apnea 77
Appendix 195
Apple jelly 41
Arachidonic acid metabolites 9
Arch wiring 249
Argon laser 227
Ariboflavinosis, fissuring of 137
Arnold-Chiari syndrome 120
Arrhythmia 73, 196, 272
Arterial
angioma 109, 110
bleeding 82
bruit 199
disease, peripheral 64
dissection 201
hemorrhage 62
injury
direct 195
indirect 195
obstruction 195
oxygen saturation 178
pulsations 199
system, diseases of 195
thrombosis 195
atherosclerotic 197
ulcer 40, 43, 43f, 44, 44t, 220
Arteriography 201
Arteriovenous
fistula 38, 133, 199
malformation 103
Artery
aneurysm, innominate 121
forceps 224f, 336, 338
Arthritis 29
Arthroscopic surgery 243
Arthroscopy 2
Arytenoidectomy 282
Arytenoidpaxy, lateral 282
Asepsis, surgical 57
Aseptic ulceration 195
Ashoff giant cells 11
Aspergillus niger 138
Aspiration pneumonia 141, 146, 177
risk of 77
Ataxia 184
Atherosclerosis 40, 195, 207
Atrial fibrillation 271
Atropine 232
Auditory
canal, external 15
nerve 191
Auriculotemporal nerve 157
Autoimmune 281
chronic 279
disease 8, 125, 169
thyroiditis 265
Avulsion
fracture 240
wound 48, 49
Axilla 17, 58
Axillary
artery 203
vessels 17
Axillofemoral graft 203
Axonal injury, diffuse 183
Axonotmesis 189, 190f
B
Babcock's forceps 335, 335f, 336
Bacillus anthracis 29, 30
BACTEC method 24
Bacteremia 14, 20
Bacterial
degradation 9
endocarditis, subacute 140
infection 4042, 66, 140, 159
synergistic gangrene, postoperative 212
Balloon tip catheter 72
Bandage 353
recurrent 68, 355, 356f
types of 357, 358f
Barbiturate poisoning 174
Bard Parker knife handle 339, 340f
Barium swallow 118
Barrel bandage 356, 357f
Bartonella henselae 160
Basal cell carcinoma 40, 46, 46f, 83, 300
Basophils 11
Battle's sign 183, 253
Bazin's ulcer 40
Beam radiotherapy, external 166
Bedsore 209b
formation, mechanism of 210fc
occipital region 209f
sacrum 209f
stage of 209f
Beef tendon 328
Behçet's disease 135
Bell's palsy 193
Bell's phenomenon 193, 193f
Benzodiazepines 232
Berry, ligament of 262
Berry's sign 287, 287f
Bicoronal flap incision 254
Bile duct, common 227
Biodegradable implants 243
Biodegradable plates 250
Biological dressings 220
Biopsy 40, 148
endoscopic 309
form 310f
image-guided 308
indications of 307b
open 164
types of 307
Bipolar cautery 226f
Bipolar device 226
Bisgaard regime 220
Bite 50
deformity, open 249f
Bjork flap 177f
Bladder, care of 187
Blanket suturing 332, 332f
Bleeding 77, 218
compartment of 183
control of 1, 63, 64fc
disorders 7, 62, 67
acquired 67
congenital 68
gums 68
management of uncontrolled 69fc
peptic ulcer 227
plane of 183, 184
source of 62
time 7, 67
vessel 62
number of 183
size of 183
Blepharoplasty 254
Blindness 214, 231
Blocking drugs 263
Blom-Singer valve 174
Blood 14, 40
collection 65
film, peripheral 42
fraction of 67
gas analysis 72
grouping 65, 65t
loss 63
measurement of 63
speed of 63
volume of 63
pressure 63, 72, 184, 235
storage 65
sugar 7, 39, 42
supply 64
transfusion 62, 65, 66
complications of 66
mismatched 66
urea 7
vessels 104, 108, 180, 183, 300, 312
small 11
volume, restoration of 63, 65
Blue nevus 100
Bluish discoloration of tongue 5
Boils, complications of 15
Bone
atrophy 240
clamps 251
cyst, simple 240
destruction 318f
diffuse rarefaction of 240
diseases of 289, 290
fracture compressing artery 210
generalized diseases of 240
inflammation of 8
local diseases of 240
marrow 131
biopsy 129
irradiation 231
nibbler 343, 343f
pain 28, 128
scan 100, 129
staples 251
types of 239
wasting 198
wax 224
Bony fragments, reduction of 247
Bony metastasis 100, 290
Borrelia vincentii 21, 45, 135, 136
Bowel, care of 187
Brachial plexus injury 73
Brachiocephalic artery 199
Brachytherapy 166, 229
Bradycardia 184, 266
Bradykinin 9
Brain 180
abscess 30
damage, causes of secondary 180b
injury 183
metastasis 100
control of 230
surgery, endoscopic 2
Brainstem receptors 112
Branchial
arch remnant 104
cyst 104, 115, 116f, 121, 161
fistula 38, 39, 116, 117f
external opening of 116f
track 117f
Branchiogenic carcinoma 116
Branham's sign 111
Breast 240, 300
carcinoma 133f, 136f, 230, 231
fibrocystic disease of 101
primary tumor 290
Breath sounds 77, 79
Breslow's thickness of lesion 99
Brittle nails 198
Brodie's fistula director 344, 344f
Bronchitis, chronic 174
Bronchoconstriction 9
Bronchodilators 7, 73
Bronchopneumonia, severe 174
Bronchospasm 73
Bronchus, primary tumor 290
Browne's tubes 60
Bruising, mild 15
Bruit 102
Brush cytology 307
Buccal mucosa 6, 143
carcinoma 146, 146f, 150
Buccinator 157
Buerger's disease 40, 195, 204, 205t, 206, 207
Buerger's exercises 201
Buerger's position 201
Buerger's posture test 198, 198f
Bulb, accidental inflation of 351
Bulbar poliomyelitis 174
Bullet wounds in limbs, management of 49
Bupivacaine 237
Burkitt's lymphoma 125, 130, 302
Burkitt's tumor 292
Burn 77, 195, 312
chemical 312, 318
complications of 317, 317b
degrees of 313
external 317
full thickness 313f
internal 317
management of 314
pathophysiology of 313, 313b
percentage area of 314
scar, management of 317
second degree 313f
severe 65
space of 121
various degrees of 313f
wound, depth of 313b
Butterfly
fracture 248
lesion 20
Buttock claudication 198
Bypass graft 202, 203t
extra-anatomical 203
Bypass procedures 134
Bypass, type of 203
C
Cachexia, malignant 146
Cadavaric position 171
Cafe-au-lait spots 87, 87f, 88, 100
Calcification 221
Calcitonin 288
Calcium 290
channel blockers 206
diet, low 291
Calf claudication 198
Calf muscle, hematoma of 222
Calf ulcer 40
Callus, stage of 241
Cancellous bone 239, 241
Cancer 14
gynecologic 230
Cancrum oris 21 137, 195, 211
spread of 21fc
Candida albicans 135, 138
Cannula 72f, 342f
Canon ball shadow 100
Capeline bandage 355, 356f
Capillary
hemangioma 109
hemorrhage 62
refilling 199
Capreomycin 25, 27
Carbimazole 263, 273
Carbolic acid 211
Carbon dioxide laser 227
Carbuncle 18, 211
back 18f
Carcinoma 121, 161, 168, 265, 279
anal canal 230
in situ 228
medullary 274, 278, 278, 278b
simplex 100
Cardiac
arrhythmia 73, 312
circulatory collapse 74
failure 133, 271
monitor 81
Cardiogenic shock 70, 73
Cardiovascular disease 214
Cardiovascular syphilis 28
Cardiovascular system 6, 271
Caries 6
cervical spine 24
teeth 19
Carotid artery 102, 199
aneurysm 102, 121
branch of external 262
feeling pulsations of 287f
internal 146
rupture 127
terminal branch of external 199
Carotid body
receptors 112
tumor 102, 112, 112f, 115, 121
Carotid triangle 121
Carotid vessels 17
Carpal tunnel syndrome 86, 207, 208
Carpopedal spasm 289, 289f
Cartilage, destruction of 33
Caseous necrosis, foci of 359
Cat scratch
disease 13, 126, 160
fever 125
Cat's paw retractor 340, 340f
Cataract 231
Catarrhal inflammation 12
Catheterization
complications of 351
indications of 350
technique of 350
Catheters size of 349
Causalgia 206
Cauterize blood vessels 227
Cavernous angioma 109, 110
Cavernous hemangioma 100, 103, 143
lower cheek 110f
tongue 110f
Cavernous sinus 189
thrombosis 15, 188, 255, 302
Cavity 77
preparation 236
Cefuroxime 19
Cell death, minimal 12
Cells, inflammatory 9, 11, 281
Cellular immunity 14
Cellular pleomorphism 128
Cellularity, mixed 128
Cellulitis 14, 1719, 39, 222
complications of 19
leg 18f
Cementomes 292, 295
Central incisors, peg-shaped deformity of upper 28
Central nervous system 6, 30, 42, 235, 270, 271
symptoms 285
Central venous cannulation, complications of 73
Cephalic tetanus 31, 32
Cerebral
concussion 183
contusion 183
edema 183
herniation 183
infection 183fc
ischemia 183
laceration 183
palsy 168
Cerebrospinal fluid 120, 180, 181, 183, 186, 188, 253
Cerebrovascular accidents 193
Cerebrovascular disease 214
Cervical
disc, lateral protrusion of 208
lymph node 28, 30, 121, 122, 123, 124f, 168, 275b
lymphadenitis 124f
lymphadenopathy 28, 29, 125
causes of 125
meningocele 120f
nodes metastasis 147
rib 121, 195, 207
syndrome 86
spine
and neck 81
control 77
examination 82
painful condition of 114
spondylitis 208
sympathectomy 208
Cervicodorsal sympathectomy 206
Cervix 216, 230
Chancre, primary 139
Chancroid 40
Charle's procedure 134
Cheatle's forceps 334, 334f
Cheek 83
bimanual palpation of 155f
mucosa 154f
Chemodectoma 112
Chemoreceptor cells 112
Chemosis 19, 271
Chemotaxis 9
Chemotherapeutic agents, local 316
Chemotherapy 14, 19, 38, 52, 100, 129, 131, 148, 151, 152, 166, 265, 307
combination 360
role of 127
Chemotrines 9
Cherubism 297
Chest 77, 81, 231
examination of 82
injury 174
movements 77
pain 285
physiotherapy 7, 222
wall abscess, chronic 17f
Chin lift 77
Chloramphenicol 171
Chlorhexidine
gluconate 60
mouthwashes 135
Chlorpromazine 32
Cholinesterase inhibitors 235
Chondritis, suppurative 317
Chondroma 121, 298
Chondrosarcoma 292, 298, 299
Christmas disease 68
Chvostek's sign 289
Chylothorax 133
Chylous
ascites 133
fistula 127
Chymotrypsin 12
Circulation, management of 81t
Circulatory collapse 70, 74
peripheral 74
Circumferential wires 242
Circumoral numbness 289
Cirrhosis, alcoholic 161
Cirsoid aneurysm 111, 111f
Citrate toxicity 67
Clavicle, medial one-third of 72f
Clavulinic acid 18, 19
Claw hand 33
Claw toe 33
Cleft lip 257, 257f, 259, 261, 261b
bilateral 257f, 258f
surgical repair of 259
unilateral
complete 258f
incomplete 258f
Cleft palate 256, 257, 257f, 259, 261, 261b
bilateral 257f
incomplete 258f
surgical repair of 260
unilateral complete 258f
Clenching teeth 119f
Clip applicator 339
Clip extractor 339, 339f
Clip, closed shapes of 339f
Clofazimine 33
Clostridium tetani 31, 60
Clostridium welchii 20, 211
Clotting time 67
Cloxacillin 132
Clutton's joints 28
Coagulation failure 66, 67
Coarse hair 266f
Cocaine 237
Cold 195
abscess 23, 24, 25f, 27, 38, 104, 115, 121, 124
aspiration of 24
causes of 23
chest wall 23f
neck 45f
extremities 266
injury 40
intolerance 285
nodule 264, 265b
shock, late 72
Coleman's sign 245
Collagen
disease 207
material, degrade 11
mesh 220
Collar incision 281
Collar stud abscess, formation of 23f
Colles fracture 208
Colloid carcinoma 100
Colloid filled nodule 361f
Colon 227
multiple polyps of 299
Color duplex imaging 200, 205
Columnar cell 83
Coma 186
Compartment group, anterior 123
Compartment syndrome 50, 210
Complement fixation test 28
Complement system 9
Complete blood count 189
Composite flap 323
Compression stocking 220
Computed tomography 193, 290
scan 265
Condylar fracture 252
bilateral 246f
management 252fc
Condyloma lata 28
Congenital dermoid 104
Conjunctiva, palpebral 5
Conjunctivitis 33
Consciousness
altered level of 186
depressed level of 77
level of 81, 185
loss of 70, 186
period of loss of 186
transient loss of 186
Conservative treatment 134, 218, 220
Consolidation, stage of 241
Constipation 285, 289
Constrictive pericarditis 231
Contaminated air 15
Contre-coup injury 180
Contusion 47, 48, 180
Core biopsy 265
Core needle biopsy 308
Corneal
haziness, bilateral 28
reflex 190
Cornoy's solution 295
Corrugated drain 346, 346f
Cosmetic
appearance 218
deformity 149, 181
Costoclavicular syndrome 207
Cotton-wool appearance 296
Cough 40
impulse test 217
Countryman's lip 147
Cranial cavity 84
Cranial fossa, anterior 182f
Cranial nerve 180, 189
damage 192t
examination of 186, 189
injury 180
palsy 179, 183
Craniofacial dysjunction 253
Cranioplasty 182f
Cranium, examination of 186
Crepe bandage 358
Cresols 59
Cretinism 138, 168, 266
Cribriform appearance 18
Cricoid hook 344, 345f
Cricothyroidotomy, surgical 77, 78f
Crile's method 286, 287f
Cruciate incision 18
Crush injury 50f, 209, 209f
pathophysiology of 50fc
Cryopathic ulcer 40
Cryoprecipitate 67
Cryosurgery 228
uses of 228b
Cuff, care of 177
Cupid's bow, asymmetrical 260
Curative radiotherapy 230, 230b
Curling's ulcers 317
Current, frequency of 226
Cushing's disease 161
Cutaneous pigmentation 296
Cutaneous vasodilatation 205
Cyanosis 5, 77, 206
Cycloserine 25
Cyst, median 104, 140, 295
Cystadenoma 83
Cystic adenoma 104
Cystic degeneration 87, 360
Cystic hygroma 101, 104, 114, 115, 121, 159, 161, 363, 363f
enlargement of 114
neck 114f, 115f
Cystic swelling 108, 114, 115t, 121
in head and neck region 104t
painless 25f
soft 121
Cystic teratoma 101
Cysticercosis 101, 104, 119
masseter muscle 119f
Cystitis 231
Cysts 101, 103, 137, 265, 279
acquired 101
classification of 101, 101t
congenital 101
developmental 292
enucleation 236
infection of 304
swellings 101
type 101
Cytokines 9
release of 11
Cytology, benefits and limitations of 308b
Czyerny's retractor 341, 341f
D
Dalrymple's sign 283
De Quervain's thyroiditis 280
Dead tissues, excision of 49
Deafness 87
unilateral 179
Death, causes of 213b
Deaver's retractor 342, 342f
Decubitus ulcer 40
Degenerative diseases 7
Degloving injury 50f
Dehydration 167
Dental
abscess 140
caries 151, 16f, 231
chair anesthesia 231
cyst 101, 104, 140, 161, 292294, 294b
infection 188
problems, prevention of 68
procedures, minor 68
sinus, chronic 292, 302, 303
surgery 228b
ulcer 40, 136, 139, 147
Dentigerous cyst 104, 292294, 294b
Dentition, abnormal 259
Dentoalveolar ridge 298f
Denture 137
correction of 136
Deoxyribonucleic acid 24, 228
Depression 289
Dercum's disease 85
Dermatitis 219, 231
Dermoid 101, 121
cyst 87, 101, 104, 107t
scalp, midline 105f
tumors 299
types of 104
Dexon-S 328
Dextran 65
Diabetes 7, 14, 39, 40, 52, 161, 220, 296
control of 18, 43, 214
mellitus 24, 201, 214b
control of 196
with insulin, control of 214t
Diabetic foot 213, 214t
gangrene, prevention of 214
ulcer 214
Diabetic gangrene 195, 212, 213b, 213f
Diabetic ketoacidosis 213
Diabetic neuropathy 44
Diabetic ulcer 40, 43, 45, 45f
Diarrhea 70, 271, 285
Diathermy 223, 224, 226b
machine 225f
principles of 225
waveforms of 226f
Diazepam 32, 232
Diclofenac sodium 12
DiGeorge's syndrome 288
Digital amputation 214
Digital pressure 64
Digital subtraction angiography 201
Diphtheria 170
Diplopia 271
Discharge
examination of 42
nature of 39, 40
Discharging tubercular sinuses, multiple 24f
Discoid lupus erythematosus 144, 145
Dish faces appearance 253
Disinfection 59
Dissection 224
method 107
Distant flap 324f
Distraction osteogenesis 243
Diuresis 317
Dobutamine 72
Dog bite left cheek 51f
Domestic violence 244
Donor site 319
Dopamine 72, 73
Doppler ultrasound 222
blood flow detection 200
Dorsalis pedis artery 199
palpation of 199f
DOTS 25
Downstaging disease 129
Doxazocin 206
Doyen's mouth gag 341, 341f
Doyen's retractor 342, 342f
Dressing
parts of 353
steps of 42
Droplet infection 22
Drowsiness 187
Drug 38, 167, 168, 207, 271
addicts 208
therapy 192
Drug-resistance tuberculosis
Dry gangrene of toes, atherosclerotic 198f
Dumb-bell tumor 87
Duplex ultrasound imaging 218
Dural tear 181
Dynamic compression plate 249, 251f
Dynaplast 358
Dyshormonogenesis 266
Dyskeratosis congenital 144, 145
Dysphagia 31, 32, 141, 171, 285
Dyspnea 66, 171, 285
E
Ear 6
abnormality of 153
bandage 356, 356f
Eccentric dynamic compression plate 250
Ectopic salivary gland, tumor of 140
Ectopic thyroid 282
tissue 271
Eczema 216, 218
Edema, conjunctival 19, 271
Egg shell crackling 294
Elastoplast 358
bandage 358f
Elbow
tap 57f
tunnel syndrome 86
Elective tracheostomy 176, 177f
Electric burns 312, 317, 318f
systemic complications of 312t
Electrocardiogram 235
Electrolyte imbalance 213, 317
Electromagnetic radiations 230
Electrons 230
Elephantiasis 132
neuromatosa 88
Embolectomy 204f
Embolism 204t
Embryology 115
Embryonic remnants, cysts of 101
Emergency embolectomy 204
Emergency surgical case, management of 4fc
Emergency tracheostomy 175, 175f
Emphysema, surgical 177, 212t
En bloc excision 300
Encapsulated lipoma 84, 84f
Encapsulation, partial 360
Endemic goiter 274
Endocarditis 29
Endocrine disorders 161, 296
Endocrine neoplasia
multiple 289
syndrome, multiple 278b
Endoscopes 61
Endoscopy 2
triple 126
Endosteal cellular proliferation, stage of 241
Endothelium 9
Endotracheal
intubation 77, 77f, 77t, 171
complications of 233b
tube 233
cuffed 78f
Enophthalmos 253
Enteritis 231
Enzymes, release of 11
Eosinophilic granuloma 137, 301
Eosinophils 11
Epicranial aponeurosis 53f
Epididymoorchitis 29
Epiglottitis 170
Epilepsy 32, 181, 183
post-traumatic 188
Epiphora 33
Epiphysitis 28
Epistaxis 68
Epithelial odontomes 292, 293
Epithelial tumors 161
Epithelioid cell 24
granulomas 359
Epithelium
repair of surface 52
surface 300
Epstein pearls 140
Epstein-Barr virus 144
infection 179
serology 179
Epulis 292
carcinomatous 293
granulomatous 292
Erbium-doped yttrium aluminum garnet 227
Ergotamine 195
Erysipelas 20
Erythema 15, 151
Erythrocyanoid ulcer 40
Erythrocyte sedimentation rate 7, 24, 39, 280
Erythroplakia 144, 145
Escharotomy 316
Esmarch's bandage 357, 358f
Esophageal
injury 177
rupture 212
stethoscope 235
ulceration, extensive 34
varices 216, 218, 227
voice 174
Esophagus 227
carcinoma 172, 230
Estlander's flap 151, 151f
Ethambutol 25, 26
Ethibond 330
Ethionamide 25
Ethmoidal sinusitis 188
Ethylene oxide 59, 61
Eustachian tube obstruction 179
Euthyroid 264, 266
Ewing's sarcoma 300, 302
Ewing's tumor 240
Excision
biopsy 42, 100, 308
surgical 100
Exogenous iodine 271
Exophthalmos 283b
malignant 283
Exophytic growth 147
Exotoxin, action of 31fc
Extension 186
Extracapsular spread 152
Extradural hematoma 181, 184, 184f, 185, 188f
comparison of 185t
Extralymphatic sites 128
Extraocular muscle 190f, 271
Extremity 81
lymphedema, upper 133
Eye 6, 227
abnormality of 153
bandage 355, 356f
bulging 271
hooding of 253
incomplete closure of 33
infrequent blinking of 283
opening 186
prominence 285
Eyeballs, bulging 19
Eyelet 249
F
Face
abnormality of 153
dangerous area of 188f
formation of 256f
involvement 33
mask 77f, 232
upper part of 40
Facial
asymmetry 33
burns 318f
dysplasia, median 261
fracture 186
muscles
movement of 6
space of 31
nerve 17, 31, 33, 157, 191
branch 157, 157t, 166f
identification 165
injury 255
management 166
neuroma 161
palsy 33, 162, 166, 168, 192
causes of 193
palsy, left 162f
palsy 32, 193f
profile 6
proportions 6
puffiness 285
skeleton
fracture of 78
X-ray 246f
skin 30
symmetry 6
trauma 193
wounds, management of 54
Faciomaxillary
fractures, treatment of 247b
trauma 81f
Famotidine 232
Fascia lata 328
Fasciocutaneous deltopectoral flap 322f
Fasciotomy 317
Fasting, preoperative 232
Fat 83
cells 84
necrosis 40
Fatigue fracture 239
Fauces 6
Fecal fistula 38
Feeding jejunostomy 187
Feeling pulses, method of 199b
Feeling trachea 286f
Fegan's method 217
Femoral artery 199, 203, 218
common 203
continuation of 199
contralateral 203
ipsilateral 203
palpation of 200f
Femoral vessels 17
Femorofemoral crossover graft 203
Femoropopliteal
bypass graft 203, 203f
disease 198, 203
Fetus 231
Fever 17, 40, 66, 123, 168
constitutional symptoms 28
mild 17
Fibrin cuff formation 220
Fibrin degradation products 9
Fibrin glue 224
Fibrinogen 67
Fibrinolytic products 9
Fibrinolytic system, activation of 11
Fibrinous inflammation 11
Fibroadenoma 83
Fibroblastic proliferation 9
Fibrocavitatory lesion 25f
Fibrolipoma 83
Fibroma 83, 143, 300
Fibromyoma 83
Fibrosarcoma 300
Fibrosis 265
of tract 38
Fibrous
dysplasia 240, 292, 296, 297f
elements 109f
epulis 292
odontomes 292, 295
scarring 360
tissue 300
Figure-of-eight 355
bandage for knee 355f
Filariasis 132
Fine needle aspiration 179
cytology 7, 24, 99, 100, 129, 148, 160, 265, 273, 276, 278280, 307, 308f, 359
Finger
clubbing 5f
tremors 271
Firearm injury 183f
First aid 241
measures 314
of trauma patients 75
First-line anti-TB drugs 26t
Fistula 37, 38, 39f, 166, 188
acquired 38
congenital 38
examination of 38
external 38
in ano 38, 39
internal 38
Fistulogram 40
Fistulography 168
Fixation
external 242
internal 242
methods of 250f
Flail chest 79, 80f, 174
Flap 318, 321
monitoring 325
necrosis 127, 166
types of 324f
Flat drain 346, 346f
Fleshy wart-like lesions 28
Flexible esophagoscopy 118
Flexible fiberoptic bronchoscope 233
Flexion, abnormal 186
Floating maxilla 253
Floor of mouth, carcinoma 146, 146f, 150, 300f
Fluctuation test
fallacies of 102
steps of 102
Fluid administration, monitoring of 73
Fluid calculation 166, 315
Fluorescent treponema antibody test 28
Fluorocarbons 65
Fluoroquinolones 25
Focal calcification 360
Focal neurological
deficit 187
signs 186
Foley's catheter 349, 350, 350f, 351
Follicular adenoma 273
Follicular carcinoma 274276, 276b, 276f
Follicular cyst 293
Follicular destruction 281
Follicular tonsillitis 140
Fontaine classification 198t
Foot
and ankle surgery 227
burning in 26
care 202
deformity 221
dorsum of 40
drop 33
edema of 6, 129, 285
Footballers ulcer 43
Forceps, plain 335, 335f
Formaldehyde 59, 61
gas 61
Fossa fractures
anterior 181
middle 183
posterior 183
Fossa tumor, posterior 114
Fournier's gangrene 195, 212
scrotum 212f
Four-tailed bandage 356, 357f
Fracture 239
bilateral 252
biological fixation of 243
causes of pathological 240b
cervical spine 244
classification of 239
clavicle, bandage for 357
comminuted 240
complications of 243
depressed 181b
compound 181, 239
compression 240
depressed 181
fixation 81
healing of 240, 240f
horizontal 252
lines, directions of 249f
local management of 242
mandible 176f, 248f, 250f
maxilla 245f, 246, 252, 253f, 254f
stabilization of 254f
treatment of 253
nasal
air sinuses 212
bone 244f, 246, 247f, 248f
pathological 88, 239, 293
patterns of 240, 240f
ramus 246f
ribs 212
simple 239
treatment of
newer methods of 243
open 243
types of 239
unilateral 252
zygomatic
arch 246
complex, internal fixation of 247f
Fragments
displacement of 249f
stable fixation of 247
Franeum linguae, short 153
Free anterolateral thigh flap 325f
Free flap 325
Frenectomy 227
Fresh frozen plasma 67
Frey's syndrome 166
Frontal bone, multiple osteomas of 299
Frostbite 195, 206, 210
Frozen section 310
biopsy 265
evaluation 165
Frozen shoulder 127
Full thickness skin graft, harvesting of 321f
Fumigation 61
Functio laesa 8
Fungal infection 137, 171
Fungating parotid tumor 164f
Fungi 8
Furuncle 30t
Furunculosis, pigmented scars of 35
Fusiform 111f
aneurysm 111
G
Gallbladder 195
Gamma irradiation 61
Gamma rays 59
Ganglion 87
Gangrene 195, 195b, 198, 204, 212, 214, 312
causation of 195
causes of 195
chemical 211
dry 195, 197f
individual causes of 197
infective 211
rapid onset of 212
spread of 196
toes, dry 205f
treatment of 196
Gardner's syndrome 299b
Gas gangrene 53, 195, 211, 211f, 212
prevention of 212b
Gastric contents
acidity of 232
during intubation, aspiration of 233
Gastric ulcer 317
Gastroenteritis 21
Gastroesophageal
junction 347
reflux disease 171
Gastrointestinal
hemorrhage 231
tract 6
Gelatin 65
Gene 54
General anesthesia 19, 231, 232, 282
stage of 232
Genital lymphedema 133
Genitalia 28
Genitourinary
system 6
tract 47
actinomycosis 30
Geographic tongue 138
Giant cell 11
epulis 293
granuloma 292, 294, 297, 298, 298f, 298t
peripheral 298f
Gibbon's catheter 349, 350, 350f
Gigli saw 343, 343f
Gillies temporal approach 246, 247f
Gingiva 6
carcinoma 147
Gingival procedures 236
Gingivectomy 227
Gingivitis 8, 16f
Gingivoalveolar cancers 151
Glabulomaxillary cyst 140
Gland
duct of 156
minor 156
Glandular carcinoma 100
Glandular epithelium 300
Glandular fever 125, 126, 142
Glandular tissue 83
Glasgow coma scale 77, 186, 186t, 187
Globulomaxillary cyst 104, 296
Glomerulonephritis 141
Glossitis 8
migrans 138
Glossopharyngeal nerve 191
Glottic tumor 174
Glutaraldehyde 61
Glycopyrrolate 232
Goiter 266, 271
classification of 266, 267b
formation 266
hardness of 268
outcome of 269fc
Goitrogens 266
Gold weight upper eyelid implants 166
Gonorrhea 29
Graft thickness 319f
Gram staining 40, 42
Granny knot 330, 330f
Granulation tissue 41
Granuloma formation 13
mechanism of 13fc
Granulomatous inflammation, chronic 13
Graves' disease 270273, 283, 285
Gravid uterus 216
Gravitational ulcer 219
Greater auricular nerve 157
damage 166
Greater palatine nerve, neurofibroma of 140
Greenstick fracture 240
Grievous injury 54
Groin 17, 58, 215
spica of 355f
Growth disturbance 301
Guerin sign 253
Gum, inflammation of 8
Gunning splint 251
H
Haemophilus influenzae 32, 170
Hair, loss of 198
Hairy tongue 138
Halogens 59, 60
Hamartoma 101, 104, 108, 114, 138
Hand
burning in 26
dorsum of 87
method 315
surgery 64
Hand-held Doppler ultrasound 218
Hand-Schuller-Christian disease 301
Hansen's disease 32
Hard lymph nodes, multiple 125f, 126f
Hard palate 6, 35, 147
carcinoma 150
Hard tissue movement, symmetry of 6
Harmonic scalpel 228
Harvey's sign 199, 200f
Hashimoto's thyroiditis 265, 274, 279
Head and neck
burns 78, 79f
cancers 230
irradiation 231
manifestations 28, 29, 35
pulses 199
region
burns of 171
fracture of 244
scalds of 171
Head bandage 355
Head injury 174, 180, 183fc, 188
classification of 180, 180t
delayed effects of 188b
mechanism of 180
minor 187b
pathophysiology of 180
patient, management of 185
Head tilt 77
Headache 66, 289
constitutional symptoms 28
post-traumatic 188
Heal superficial ulcers 205
Healing, normal 15
Heart 205, 312
examination of 199
failure 196
congestive 42, 66, 67, 111, 222, 272
left 73
right 73
treatment of 317
rate 63
Heat 8, 195
Heat intolerance 271, 285
Heat sensitive equipment 59
Heimlich maneuver 170
Hemangioma 87, 101, 104, 108, 115, 121, 137f, 139, 143, 218, 227, 300
natural history of 109t
small 228
type of 109
Hematemesis 317
Hematogenous spread 99
Hematoma 14, 47, 48, 101, 104, 166, 201, 218
expanding 82
intracranial 48, 181, 183
large extradural 185f
stage of 241
Hemiplegia 214
Hemithyroidectomy 276b, 310f
Hemoglobin 7, 39, 42
Hemophilia 67, 68
A 68
B 68
Hemophilics, management of 68
Hemopoietic cells 300
Hemorrhage 62, 70, 104, 127, 141, 146, 177, 221, 260, 265, 267, 282, 282f, 360
acute 63
chronic 63
classification of 62, 63t
control 80
external 62, 81
infratentorial 184
internal 62
intracerebral 185, 186f
intraventricular 185
mild 63
moderate 63
primary 62
reactionary 62
secondary 62
severe 63, 177
torrential 62f, 111
treatment of 63
Hemorrhoids 216, 218
Hemoserous discharge 15
Hemostasis 49, 224, 336
Hemostat 336
Hemothorax 73
Hepatic failure 68, 133
Hepatitis 34, 231
B 34, 35
infection 35
positive 35
vaccine 34
C 34
Herpes infection 35
Herpes stomatitis 136
Herpes zoster 35, 193
Heterosexual contacts 34
Hidradenitis suppurativa 37
High sleeping pulse rate 271
Histamin 9
Histiocytosis X 300, 301
Hodgkin's lymphoma 11, 127, 128, 128f, 128t, 230, 359, 360f
primary 125
Hollow viscera 47
Homan's procedure 134
Homan's sign 221
Honeycomb liver 30
Hormonal diseases 7
Hormone levels 264t
Horner's syndrome 206
Hospital-acquired infection 14
Hot nodule 264
Hudson's brace and burr 342, 343f
Huge sublingual dermoid cyst 104f
Human albumin 65, 67
Human embryo, head of 256f
Human immunodeficiency virus 24, 30, 34, 35, 38, 161
infection 34, 35, 52
Human papillomavirus 144
Humby skin grafting knife 344, 344f
Humidification 171, 176
Hunterian chancre 27
Hutchinson's pupil 184, 186
Hutchinson's teeth 29, 29, 137
Hutchinson's triad 29
Hydatid cyst 101
Hydration 142, 222, 317
Hydrocele 133
Hydrocephalus 120
post-traumatic 188
Hydrochlorothiazide 161
Hydrocolloids 43
Hydroxyethyl starch 65
Hyperabduction syndrome 207
Hyperbaric oxygen 212
Hypercalcemia 291
causes of 290b
Hypercholesterolemia 201
Hyperglycemia 180
Hyperhidrosis 206
Hyperinflated chest 79
Hyperkalemia 67
Hyperparathyroidism 88, 240, 289, 289b
Hyperplasia 132, 289
Hyperplastic
candidiasis, chronic 144, 145
goiter, diffuse 267
Hypersensitivity
reactions 8
states 11
Hypertension 201
Hypertensive ulcer 40
Hyperthermia 14, 180
Hyperthyroid 264, 266
Hypertrophic masseter 161
Hypertrophic scar 55, 55f, 56, 56t, 317
Hypertrophic soft palate 178
Hypocalcemia 67, 282, 289f
Hypocalcemic tetany, causes of 288b
Hypoglobus 245
Hypoglossal nerve 31, 143f, 157, 159f, 191
Hypoglycemia 214
Hypokalemia 288
Hypoparathyroidism 288
Hypopituitarism 266
Hypoplasia 132
Hypoproteinemia 52, 133
Hypotension 14, 73, 79, 180
sudden 70
Hypothalamic pituitary thyroid axis 263
Hypothermia 14, 67, 68
Hypothyroid 264, 266
Hypothyroidism 161, 265, 281, 282
hypothalamic 266
symptoms of 285
Hypovolemic shock 70, 73, 317
types of 71t
Hypoxia 180, 187
diffusion 235
I
Ileofemoral
disease 198
thrombosis 216
Iliac artery, continuation of external 199
Iliac crest marrow biopsy 129
Iliac fossa, right 30
Iliac lymphadenopathy 216
Iliofemoral
bypass graft 203
disease 203
Immunity 34
humoral 14
lowered 14
Immunologic cell injury 11
Immunosuppression 66, 67
Immunotherapy 100
Impetigo 20
Implantation 101
dermoid
ear lobule 106f
ring finger 106f
Incision avulsion method 107
Inducible nitric oxide synthase 10
Indwelling catheter 349
Infant feeding tube 347, 348f
Infarction 214
Infection 8, 14, 66, 73, 103, 108, 114, 120, 127, 141, 166, 181, 183, 193, 240, 260, 293
acute 14, 39, 124
adjoining area of 15
chronic 7, 11, 14, 39, 124
specific 38
control of 1, 196
localized 14
prevention of 247
primary 14
secondary 14, 114
spread of 14
types of 14, 15
Infertility 231
Inflammation
chemical mediators of 9t
gangrenous 12
phase of 51
primary chronic 13
signs of 8, 15
suppurative 11
types of 8
Inflammatory disorders 158
Infrarenal aorta 203
Ingestion 22
Injury
acceleration 180
accidental 55
cause of 186
circumstances of 186
deceleration 180
high energy mechanism of 186
high-voltage 317
ischemic 8
low-voltage 317
Inotropic drugs 72
Insomnia 188, 285
Interleukin-1 11
Intermittent claudication 197, 202, 204
Intestines 195, 231
large 83
small 83
Intra-arterial drugs 208
Intracranial
compartments, surgical anatomy of 183
pressure
management of raised 187fc
raised 127, 180, 181
Involucrum 304
Iodine deficiency 266
Ionizing radiations, types of 230
Iridocyclitis 29
Iritis 28
Irradiation 195, 274, 312
Irritability 188
Ischemia 38
Isoniazid 25, 26
Isonicotinylhydrazide 25
Isopropyl alcohol 61
Isotonic fluid 72
Isotope
lymphoscintigraphy 133
scan 264, 277
Itching 26
indurated papule 30
Ivy loop wiring 249
J
Jaffe's syndrome 296
Jarisch Herxheimer reaction 29
Jaundice 5, 5f, 14, 26, 52, 66, 123, 129
Jaw
actinomycosis of 305
clinical examination of 306
cysts, complications of 293b
exercise, functional 252
fracture of 304
jerk 190
movement 6
necrosis of 304, 305
osteomyelitis of 302, 303
swellings 292
classification of 292b
syphilis of 305
thrust 77
traumatic fractures of 138
tumor 292, 296, 361f
Jod-Basedow's thyrotoxicosis 271
Joffroy's sign 283
Johansen stepladder procedure 151, 151f
Joint pain 26, 28
Joint space, synovial lining of 87
Joll's thyroid retractor 341, 341f
Jugular group
lower 123
upper 123
Jugular vein, internal 127
Jugulodigastric nodes 122
Jugulo-omohyoid nodes 122, 123
Juvenile rheumatoid arthritis 125
K
K-90 catheter 349
Kahn test 42
Kanamycin 25, 27
Kangaroo tendon 328
Kaposi's sarcoma 34, 35, 100
Keloid 55, 55f, 56, 56t
formation 282
sternum 55f
Keratin horn 83
Keratitis 33
exposure 33
interstitial 28, 29
Keratoacanthoma 147
Keratoconjunctivitis sicca 167
Keratocyst 104, 292
Kernohan's notch 184
Key hole surgery 243
Kidneys 231, 290
primary tumor 290
Kinin system 9
Knee amputation
above 214
below 206, 214
Knot, instrumental tying of 331f
Knot, types of 330f
Kocher's forceps 337, 337f
Kocher's test 286
Kocher's thyroid
dissector 344, 344f
retractor 340, 341f
Kyphosis 24
L
Lacerated wound 48, 49
cheek 49f
forehead 53f
upper lip 49f
Lacrimal sac 104
mucocele 104
Lag screws 251, 251f
Lahey's forceps 337, 337f
Lahey's method 286, 287f
Lahshal system 258, 258f
Lamb's wool 202
Lane's tissue forceps 335, 336f
Langenbeck's retractor 341, 341f
Langhans' giant cells 11, 24, 359
Laparoscopic lumbar sympathectomy 206
Laparotomy 81
Laryngeal
edema 19
fracture 82
mask airway 78f, 232, 233f
nerve
injury, recurrent 177
palsy 172f
recurrent 263f, 281, 282f
stridor 289
tumors, advanced 174
Laryngectomy, partial 174
Laryngitis
acute 171
chronic 171
Laryngocele 104, 118, 121, 171
Laryngofissure 174
Laryngoscopy
direct 234f
indirect 268
Larynx 104, 170, 174, 233
artificial 174
carcinoma 172, 173t, 174
diseases of 170
tumor of 172
Laser
applications of 227b
coagulation 227
effects of 227b
endarterectomy 227
lithotripsy, endoscopic 227
surgery, endoscopic 174
Laser-assisted in situ keratomileusis 227
Lax skin 55
Le Fort
classification 253f
fracture 252, 253, 253b
Leg
cramps, severe 218
moist gangrene of 196f
ulcer 220b
infective 40
Leiomyoma 300
Leiomyosarcoma 300
Leonine facies 24, 33
Leprids 33
Lepromatous leprosy 33, 34
Lepromin test 34
Leprosy 13, 23, 32, 33, 33t, 40, 44
classification of 33f
Leriche's syndrome 198
Lesion
congenital 174
treatment of primary 100
Letterer-Siwe disease 301
Leukemia 30, 123, 130, 135, 300
acute 130
chronic 130
malignancy 107
Leukemic cells 131
Leukocyte 9, 66
adhesion 9
extravasation 9
Leukocytic count 7, 39
Leukocytosis 14
Leukoplakia 144, 147
Leukotrines 9
Liberal skin incision 49
Lichen planus 135, 136, 138, 228
Lid lag 271
Lid retraction 271, 283
Lid tightening, lower 166
Lidocaine 236, 237
Lignocaine 237
Limb
amputation 317
edema, unilateral 123
injury causing arterial
division 210
thrombosis 210
ischemia, chronic 197, 198, 204, 214
lower 202, 202fc
ischemia, lower 198t
perforating veins of lower 216f
pulses, lower 199
saving 197
thin 198
venous system, surgical anatomy of lower 215
volume measurement 134
weakness 186, 187
Limbus, upper 283
Limited jaw movements 162
Linear accelerator 229
Lines of langer 223
Lingual artery, erosion of 146
Lip 6, 83, 135, 147
anatomy of 256, 256f
and nose, boil upper 15
carcinoma 147, 150
chancre of 28, 140
cracked 139
diseases of 139
embryology of 256
lesion of 153
lower 110f, 137f
mucosa of 136f
muscles, lower 157
shave procedure 151f
swelling upper 253
tissues, deficient 260f
Lipedema 132, 133
Lipodermatosclerosis 44, 44f, 216, 219, 220f
Lipoma 84, 85, 87, 102, 115, 121, 162, 300, 362, 362f
back in scapular region 84f
diffuse 84, 85f
multiple 85
shoulder 84f
Lipomatosis, diffuse 133
Liposarcoma 300
Liposuction 134
Lithium 290
Liver 30, 231
biopsy 129
dysfunction, deranged in 7
function tests 7, 129
metastasis, ultrasound abdomen for 100
tumors, ablation of 227
Lobe tumors, deep 166
Lobectomy 269
cut section, left 360f
Local anesthetic
eutectic mixture of 237
function of 236t
Local tetanus 31
Lock jaw 32
Lorazepam 232
Lower alveolar ridge, carcinoma 147f
Lucid interval 184
Ludwig's angina 19, 19f, 140, 170, 302
Lugol's iodine 273
Lumbar sympathectomy 205, 206b
Lung 240, 300
cancer 230
fibrosis 231
involving left hilum, carcinoma 172
upper part of 121
Lupus vulgaris 24
Lymph node 87, 104, 121, 126, 128, 153
assessment for metastasis 165
biopsy 24, 126, 129, 360
operative steps of 127
clinical examination of 123
diseases of 122
enlargement 131
examination 6
of draining 39
groups of 129
in neck 40
levels of 123
involvement 128
mass 102, 275f, 359f
metastasis 147, 152
multiple 152
palpation of 124
Lymph vessels 300
Lymphadenitis 14, 19
acute suppurative 125
chronic nonspecific 125
Lymphadenopathy 34, 301
generalized 28
Lymphangiography 133
Lymphangioma 108, 114, 115, 138, 139, 143, 300
Lymphangiosarcoma 133, 300
Lymphangitis 14, 19
acute 132
Lymphatic
elements 109f
obstruction 222
spread 99
Lymphatic system 123
anatomy of 131
diseases of 131
physiology of 132
Lymphedema 132, 133
left arm 133f
moderate 133f
primary 132
secondary 132
shoulder 133f
Lymphocytes 11, 14, 24
Lymphocytic
depleted 128
infiltration 281
leukemia, chronic 125
predominant 128
thyroiditis 279
Lymphoid leukemia
Lymphoid types 131
Lymphoma 34, 35, 100, 124, 167, 143, 162, 179, 274, 300, 359
malignant 278
Lymphovenous anastomosis 134
Lysosomal enzymes 9
M
Machinery murmur, continuous 199
Macrocheilia 139
Macroglossia 138
Macrophages 9, 11, 14
Maduramycosis 23
Magnesium sulfate ointment 42
Magnetic resonance
angiography 201
imaging 2, 148, 193, 265, 290
venography 222
Malaise 289
Malaria 66
Malecot's catheter 351, 351f
Malleable probe 344
Malleolus, behind lateral 215
Malnutrition 14, 38, 161, 209, 317
Mandible
dental cyst of 293f
dentigerous cyst of 294f
examination of 306
fracture 245, 248
angle of 246f
treatment of 249
malignant
melanoma of 363, 363f
tumors of 300
multiple osteomas of 299
ossifying fibroma of 297f
osteosarcoma of 361
reconstruction 323f
squamous cell carcinoma of 361, 361f
Towne's view of 245
tumor of 121
X-ray 303
Mandibular body, bony destruction of 305f
Mandibular fracture 186
sites of 248f
Mandibular nerve 157
Mandibular resection 149
Mandibular symphysis 295f
Mandibular tumor 161
Mantoux intradermal test 24
Manubrium sterni 121
Marjolin's ulcer 40, 46, 46f, 56, 220, 317
Marrow epithelium 300
Mask ventilation 233
Massive hemothorax 79
Massive nasopharyngeal bleeding 79
Massive surgical emphysema 80f
Massive transfusion, problems of 67
Mast cells 9
Mastectomy 133
Mastication, restoration of 247
Maternal epilepsy 257
Maternofetal transmission across placenta 32
Mattress suturing 332
Maturation 55
Maxilla 244
examination of 306
fracture of 245, 252
malignant tumors of 301
repositioning of 253
Maxillary
antrum, carcinoma 38
antrum, floor of 147, 150
complex, testing mobility of 245f
sinus
infection of 255
invading palate 140
sinusitis 304
Maxillofacial
fractures 239, 244
complications of 255
injury 77
significant 186
Maxon 330
Mayo's scissors 340
Mayo's towel clip 334, 334f, 335
Mazabraud's syndrome 296
Medial malleolus, front of 215
Mediastinal irradiation 231
Mediastinitis 19
Mediastinoscopy 129
Mediastinum 114
Medulloblastoma 230
Megavoltage 229
Meige's disease 132
Melanoma 99
benign 300
in situ 99
malignant 40, 100, 130, 143, 300, 302
treatment of 99
Meleney's gangrene 212
Membrane phospholipids 9
Memory, defective 188
Meninges 104
Meningitis 14, 29, 32, 181, 193
Meningocele 103, 104, 119, 120t
Meningomyelocele 120, 120t
Mental sinus, median 37, 37f, 39, 303
Mephentine 73
Mesenteric lymph node biopsy 129
Mesh graft 320, 322f
Mesothelial odontomes 292, 295
Metabolic
acidosis, correction of 73
alkalosis 67, 288
diseases 7
Metal instruments 61
Metallic tube 345, 345f
Metastatic bone disease 230
Metastatic carcinoma 240
Metastatic cervical lymph nodes, staging of 126
Metastatic deposits 143, 300, 359, 360
Metastatic lymph nodes 147
Metastatic malignant melanoma, treatment of 100
Metastatic nodes 127
Metastatic skin deposits 130
Metastatic thyroid carcinoma 271
Metastatic tumor 162, 300
Methyldopa 161
Metoclopramide 232
Metronidazole 212
Microcarcinoma 274
Microorganisms, phagocytosis of 11
Microvascular free flaps 300
Midazolam 232
Middle finger, dry gangrene of tip of 196f
Mid-jugular group 123
Miliary tuberculosis 23
Millard's technique 260, 260f
Milroy's disease 132
Moebius sign 283
Moist gangrene 195, 197t
Moisture 209
Molecular weight heparin, low 222
Mongoloid slant 245
Monilial
stomatitis 135
ulcer 136
Monocryl 328
Monocytes 9
Monomorphic adenoma 161
Mononucleosis, infectious 126, 142
Monopolar cautery 226f
Monopolar device 225
Monostotic fibrous dysplasia 297f
Monostotic lesion 296
Morphine 232
Morris retractor 342, 342f
Morton's metatarsalgia 86
Mortorell's ulcer 40
Moses sign 221
Mosquito forceps 336, 336f
Moth eaten alopecia 28
Motor function 190
Motor neuron
lesions, lower 193
lesions, upper 193
palsy, lower 172
Motor power 42
Moulding, sign of 106
Mouth 77, 135
bimanual palpation of floor of 169f
causes, dry 167
dry 231
floor of 6, 143, 154f, 157f, 158f
Moynihan's tetra-towel clip 335, 335f
Mucoepidermoid carcinoma
high-grade 161
low-grade 161
Mucoepidermoid tumor 163
high-grade 164f
Mucoid carcinoma 100
Mucosa 14
color of 235
Mucosal cells, exfoliative cytology of 307
Mucositis 231
Mucus
retention cyst 137, 157, 158f
thin 38
Multinodular goiter 266, 267, 276f, 280, 360f,
large 268f
operative specimen 360f
part of 279
Multiorgan failure 213
Multisystem organ failure 14
Muscle 56, 83, 104, 312
pain, ischemic 207
relaxants 232, 234
smooth 300
spasm, smooth 283
wasting 10, 198
weakness 289
Mycobacteria 171
Mycobacterium avium 27
Mycobacterium fortuitum 27
Mycobacterium kansasii 27
Mycobacterium leprae 32
Mycobacterium tuberculosis infection 13
Myelocele 120
Myeloid 131, 292
epulis 293
leukemia 131
Myeloma, multiple 11, 207, 240, 290, 300, 301
Myer's vein stripper 344, 344f
Myocardial infarction 8, 204, 231
Myocardial receptors 112
Myocutaneous latissimus dorsi flap 322f
Myoglobinuria 312
Myositis ossificans 48
Myxedema 133, 208, 222, 266, 266f, 286f
Myxofibromatous degeneration 88
Myxomatous degeneration 85, 87
N
Naffziger's method 283, 285f
Nail
beds 5
flat 5f
intramedullary 242, 242f
Narcotic analgesics 315
Nasal
airways 232
boil 188
bones, fracture of 247
bridge 244
collapse of 33
contour of 244f
deformity 178, 253
discharge 28, 29
obstruction 179
process, medial 256
surface 306
tip, lifting of 33
Nasogastric
intubation 315
tube 187
Nasolabial cyst 104, 295
Nasopalatine cyst 104, 140, 295
Nasopharyngeal
airway 77, 77f, 233f
carcinoma 179
fiberoptic endoscopy examination 178
growth, biopsy of 179
Nasopharynx 126, 177
diseases of 170
surgical anatomy of 177f
tumor of 178
Nasotracheal intubation 234
National Institute for Health and Clinical Excellence Guidelines 187b
Natural killer 10
Natural orifice transluminal endoscopic surgery 2
Nausea 66
Neck 17, 19, 77, 82
abscess 35
anterior triangle 121t
bandage 357, 357f
block dissection of 300
dissection
complications of 127
types of 127
injury 172
irradiation 274
local examination of 286
mass 121
nodes 148
appearance of 268f
biopsy of 179
management of 166
treatment of 149, 152
posterior triangle of 115t, 121t
root of 207f
stiffness 32
swelling 101, 121, 282f
multiple 153
transverse section of 262f
wound 346f
Necklace incision 281
Necrosis
Necrotic tissue 14, 52
Necrotizing inflammation 12
Needle biopsy 308, 308b
steps of 308
Needle cricothyroidotomy 78
Needle curvatures, basic 327f
Needle holder 338, 338f
Needle points, types of 328f
Needle, parts of 327, 327f
Negative suction
closed drainage system 346f
wound therapy 54f
Neisseria gonorrhoeae 29
Neodymium-doped yttrium aluminum garnet 227
Neoplasm 11
Nephropathy 214
Nephrosclerosis 231
Nephrotic syndrome 222
Nerve 33, 47, 108, 189, 262
accessory 127, 191
block, sites of 237f
cells 300
compression, causes of 86
damage 281
deafness, eighth 28
fibers intact 189
hook 340, 340f
injury 189, 218
classification of 189, 189t
types of 190f
involvement 33t, 34
lingual 159f
median 33
pressure symptoms 208
relation of 263f
repair of 64
sheath 83
Neural dysfunction 301
Neuraxial blocks, central 237
Neurilemmoma 85
Neuroblastoma 300
Neuroectoderm 300
Neuroendocrine 10
Neurofibroma 83, 85, 87, 108, 121, 138, 143, 162, 300
complications of 87
localized 86
multiple 86f, 87, 88
Neurofibromatosis 133
generalized 87, 87f
Neurofibrosarcoma 300
Neurogenic
shock 70, 317
ulcer 40, 44
lateral malleolus 44f
sole 44f
Neuroma 85
false 85
Neuromuscular blockers 234
Neuropathic ulcer 40, 42, 220
Neuropathy 14, 214
peripheral 213
Neuropraxia 189, 190f
Neurosyphilis 28
Neurotmesis 189, 190f
Neurovascular bundle 49
Neutron 230
radiotherapy 166
Neutrophils 9, 11
Nevus 108
Nicolandi's sign 111
Nifedipine 206
Nitric oxide 9
Nodular lesions 33
Nodular melanoma neck 99f
Nodular sclerosis 128
Nonabsorbable sutures, properties of 329t
Nondepolarizing neuromuscular blockers 234
Nonepithelial tumors 162
Nonhealing sinus 24
causes of 38
cheek 39f
forehead 38f
Nonhealing ulcer 143f
Non-Hodgkin's lymphoma 125, 128, 128t, 130
Noninvasive ventilation 79
Non-odontogenic cysts 104, 120, 295
Nonosseous
jaw tumors 299, 300t
tumors 292
Nonsmall cell 230
Nonsteroidal anti-inflammatory drugs 10, 12, 280
Nontooth-bearing segment, fracture of 251
Nontoothed forceps 335
Nontoxic strain 60
Nose
abnormality of 153
moist gangrene of 197f
root of 104
Nosocomial infection 14
source of 15
Nucleic acid amplification testing 29
Numbness 187
Nutrition 317
Nystatin cream 135
O
Obesity 161, 178, 201, 216
Oblique paralyzed, superior 190
Obstructive sleep apnea 178
Occipital dermoid 105f
Occlusion, derangement of 253
Occult carcinoma 274
Ocular movements, limitation of 253
Ocular muscle movement 6
Oculomotor nerve paralysis 190
Odontectomy 236
Odontogenic
cysts 104, 120
keratocyst 295, 295f
tumors 292
Odontomes 293
compound 299
Olfactory nerve 189
Oligomenorrhea 271, 285
Omentopexy 205, 206
Ondansetron 232
Oophoropexy 129
Operation theaters 61
Operative methods 64
Operative reduction 242
Ophthalmia neonatorum 29
Ophthalmoplegia 19, 31, 32
Opioids 232
Opsonization 9
Optic nerve 19, 189
Oral
airways 232
biphosphonate 291
cancers 144, 145, 147, 148, 148t, 151
advanced 228
causes of late 145
staging of 148
surgical resection of 149
treatment of 148
candidiasis 167
carcinoma 144
cavity 28, 35, 39, 104, 125, 144, 147, 153f, 228b
carcinoma 19
clinical examination of 152
diseases of 135
mucus cyst in 101
neoplastic lesions of 142
non-neoplastic lesions of 135
ulcers in 136t
contraceptives 222
Kaposi's sarcoma 35
lesions 144
leukoplakia 228
lichen planus 144, 145
submucus fibrosis 144, 145, 227
suction 77
tongue 147
Orbicularis oculi 157
Orbicularis oris 157
Orbital blow-out fracture 254
Orbital cellulitis 19
Orbital fissure syndrome, superior 255
Organ dysfunction syndrome, multiple 14, 72
Organ failure, multiple system 72, 211
Organic poisons 8
Origin, tissue of 300
Orocutaneous fistula 38, 153
Orodental diseases, local examination for 6
Oropharyngeal airway 77, 233f
Oropharynx 147
Orotracheal intubation 233
Orthopantogram 293f295f, 297f, 305f
Orthopantomograph 246, 246f
Orthostatic hypotension 74
Osseocutaneous fibula flap 323f
Osseous jaw tumors 296
Osseous tumor 292
Ossifying fibroma 292, 296
Osteitis fibrosa cystica 88
Osteochondritis 28
Osteoclastic giant cells 11
Osteoclastoma 11, 240, 292, 294, 297, 298
Osteogenesis imperfecta 240
Osteogenic sarcoma 240, 299, 299f
Osteolytic lesions, multiple 276f
Osteoma 298
central 298
peripheral 298, 299f
Osteomalacia 240, 288
Osteomyelitis 8, 37, 39, 255, 292, 318f
Osteoradionecrosis 151
Osteosarcoma 292, 361f
Osteosynthesis 249
Otalgia 141
Otitis media 193
chronic suppurative 31
Otorrhea 183, 186
Ovarian tumor 271
Ovaries 216, 230, 231, 290
Overdose reaction, management of 237
Oximetry 171
Oxygen
metabolites 9
saturation 235
therapy 315
P
Pachydermatous appearance 133
Packed red cells 67
Paget's disease 240, 292, 296
Paget's test 102, 103f
Pain 8, 9, 31, 141, 168, 204, 284
abdominal 289
control of 2, 196, 201
localizing 186
relief 134, 232
severe 315
syndrome, post-traumatic 206
Painful blue leg 221
Painful masses, shrinkage of 230
Palatal cyst 140
Palatal ecchymosis 253
Palatal mucosa, squamous cell carcinoma of 140
Palatal perforation 28, 29, 137, 140
Palatal swellings 140
Palate 6, 135
anatomy of 256
diseases of 140
embryology of 256
papillary hyperplasia of 228
position of soft 259f
Palatine artery, posterior 260
Pallets, multiple 183f
Palliative radiotherapy 151, 230, 230b
Palpating submandibular lymph nodes 124f
Palpation 6, 154
Palpitation 271, 285
P-aminosalicylic acid 25
Pancoast tumor 121
Pancreatic adenoma 278
Pancreatitis, acute 288
Pancytopenia 231
Panda eyes 181
Panda face 253
Papillary carcinoma 274276
thyroid 274f, 275f
Papillary obstruction 160
Papilloma 83, 172, 300
Para-aortic lymph node
biopsy 129
enlargement 129
Parafollicular cells 274
Paralysis 204
Parapharyngeal abscess 140, 141
Paraphimosis 351
Paraplegia 44, 87, 201
Parasites 8
Parasitic infections 11
Parathormone 288f
Parathyroid
adenoma 88, 278, 291f
agenesis 288
carcinoma 289, 291
gland 288
hyperplasia 291
Paratracheal lymph nodes 121, 122, 286
Paresthesia 204, 255
Paronychia, acute 16f
Parotid abscess 104, 120, 156
drainage of 168
Parotid calculi 160
Parotid fistula 38, 168t
Parotid gland 156, 157, 161, 168
surgery 193
surgical anatomy of 156f
tumors 162, 168t
Parotid region, trauma of 168
Parotid tumor 161
left malignant 163f
malignant 162f, 165f, 193
Parotidectomy
complications of 166
superficial 162f, 165, 165f, 168, 362f
Parotitis
Particulate radiations 230
Paterson-Kelly syndrome 145
Pedicle groin flap 325f
Pedicled flap 325
Pelvic tumors 216
Pelvis 81, 231
Pemberton's sign 269
Penetrating wound 15, 49
Penicillin V 140
Peracetic acid 5961
Perchlorates 263
Percutaneous
tracheostomy 176
transluminal angioplasty 202
Perforation peritonitis 317
Perianal abscess 34
Pericardial
effusion 266
tamponade 80
Pericoronitis 292, 302, 303fc
Perineum 58
Periodontal
cyst 293
disease, accelerated 167
Periorbital
edema 271
puffiness 266
swelling 81f
Periosteal elevator 343, 343f
Periostitis 221
Peritonitis 14, 34
Peritonsillar abscess 29, 140, 141
Permanent teeth 299
Permits gaseous exchange 42
Persistent discharge 38
Persistent headache 186
Persistent vomiting 186, 187
Perthes' test 217
Pethidine 232
Peutz-Jegher's syndrome 100, 139
Phagedenic ulcer 45
Phagocytosis 9, 11
Pharyngeal airway, narrowing of 178
Pharyngeal pouch 104, 118, 118f, 121
Pharyngeal wall, posterior 6, 154f
Pharyngitis, acute 32
Pharynx 104, 233
Phenobarbitone 32
Phenols 59
Pheochromocytoma 278
Philadelphia collar 76f
Phlegmasia
alba dolens 221
cerulae dolens 221
Phosphorus necrosis 306
Photon radiations 230
Phototherapeutic keratectomy 227
Physical gangrene 210
Pierre-Robin
sequence 261
syndrome 257
Pigeon chest deformity 5f
Pigmented basal cell carcinoma 100
Pigmented lips 139
Pigmented mole forehead, excision biopsy of 310f
Pigmented nevus 137f
Pigmented senile warts 100
Piles surgery 227
Pilonidal sinus 37
Pilosebaceous elements 313
Pinna, lower 166
Pituitary adenoma 278
Pizillo's method 286
Plasma
burn causing loss of 70
cells 11
Plaster of Paris 242
Plaster, lightweight 243
Plastic disposable items 61f
Plastic instruments 347
Plastic tube 61, 345
cuffed 345f
Platelet 9, 66
activation 9
concentrate 67
rich plasma 67
Platonychia 5, 5f
Platysma 157
Pleomorphic adenoma 161, 162, 162f, 163, 163f, 163t, 166, 168, 300, 361, 362f
left 162f
malignant 300
Plexiform angioma 110
Plexiform neurofibromatosis 88, 88f
Plummer's disease 270272
Plummer-Vinson syndrome 144, 145
Plunging ranula 116, 121, 158, 158f, 159
Pneumocranium 181
Pneumomediastinum 177
Pneumonia, hemorrhagic 12
Pneumothorax 73, 127, 177
Poikilothermia 204
Poliglecaprone 328
Polio 240
Polybutylate-coated braided polyester 330
Polycystic kidney 101
Polydioxanone 328
Polyglactin 328
Polyglatin 910 329, 330
Polyglycolic acid 328
Polyglyconate 330
Polymerase chain reaction 24, 40, 42
Polymorphonuclear leukocytosis 189
Polymorphs 14
Polyostotic fibrous dysplasia 296
Polyostotic lesion 296
Polytetrafluoroethylene 203
Pond depressed fracture 182f
Poor wound healing 213
Pop bandage 358
Popliteal artery 199, 203, 218
Popliteal fossa 215
Popliteal nerve, lateral 33
Port-wine
stain 109, 109f
urine 312
Positive airway pressure, continuous 178
ventilation 80f
Positron emission tomography 2, 164, 265
Postbiopsy monitoring 307
Postpertussis ulcer 40, 139
Pott's bulldog clamp 337, 338f
Pott's puffy tumor 181b
Povidone iodine solution 354f
Prazocin 206
Preanesthetic checkup 231
Preauricular
dermoid 105f
lymph node 161
lymphadenopathy 161
sinus 37f
swelling 161
Prebiopsy monitoring 307
Precocious puberty 296
Pregangrene 198, 202
Pregnancy 81, 161
epulis 293
Prehospital information 76
Presenile atherosclerosis 205, 205t
Pressure points 209
Pressure sores 195, 209
Pressure symptoms, local 285
Pretracheal lymph nodes 121, 122, 286
Prevertebral abscess 142
Processus globularis 256
Proctitis 29
Produce parathormone 288
Profundaplasty 203
Prolene sutures, interrupted 53f
Proliferation, phase of 51
Promethazine 232
Prophylactic radiotherapy 230
Prophylaxis 32
against goiter 266, 267b
Propranolol 273
Proptosis 19, 271, 273, 283
Propylthiouracil 263, 273
Prostaglandins 9
Prostate
cancer 230
primary tumor 290
Prostatitis 29
Protein loss 317
Protein-rich fluid 132
Prothionamide 25
Prothrombin time 35, 67
Proton 230
Pseudofluctuation 84
Pseudogas gangrene 212
Pseudomembranous inflammation 12
Pseudomonas infection 38
Pseudotrabeculae 297
Pseudotransillumination 84
Psychic moans 289, 290
Puerperal tetanus 31
Puffy face 266f
Pulmonary
arterial hypertension 73
artery
pressure 73
rupture 73
capillary wedge pressure 72
embolism 222
infarction 73
metastasis 100
receptors 112
tuberculosis 22, 22fc, 42
Pulpectomy 236
Pulpotomy 236
Pulsatile swelling 102
Pulsations 102
loss of 195
Pulse 81
oximeter 72, 81
Pulselessness 204
Pupillary response 186
Purulent discharge 40, 41
Purulent sputum 7
Pus 38, 40
swab culture 189
Pustule on face, malignant 29
Pyemia 15, 20
Pyoderma gangrenosum 212
Pyogenic granuloma 138, 147
tongue 139f
Pyogenic infections 138
Pyogenic osteomyelitis 240
Pyramidal fracture 252
Pyrazinamide 25, 26
Pyrexial reactions 66
Pyridoxine 26
Pyriform sinus 126
R
Raccoon eyes 181, 182f, 186
Radiation 304
exposure 257
necrosis 305
Radical neck dissection 127, 323f
Radicular cyst 293
Radioiodine 273
Radionecrosis, risk of 151
Radiosensitivity 229
Radiotherapy 38, 148, 151, 166, 171, 229, 265, 307, 360
adjuvant 230
aims of 228
biological effects of 228, 228fc
clinical applications of 230
interstitial 229
intracavitary 229
local 52
principles of 228
role of 166
side effects of 151
toxicity of 231b
Rampley's sponge holding forceps 334, 334f
Ramsay-Hunt syndrome 193
Ramus, multilocular radiolucency of 295f
Random flap 324f
Ranitidine 232
Ranula 120, 121, 157
mucous cysts 104
Rapid painless enlargement 268
Ray amputation 214
Ray fungus 30
Raynaud's disease 195, 206, 207, 207t
Raynaud's phenomenon 206, 206f, 207, 208
Raynaud's syndrome 204, 205, 207, 207t
Reactive hyperplasia 359, 360
Recombinant epidermal growth factor 43
Reconstruction plates 250, 251f
Reconstructive surgery 2
Rectum 39, 216
Red granulation tissue 41f
Reed-Sternberg cells 11, 128
Reef knot 330, 330f
Reflex 42
paralytic ileus 315
Refractive error, treat 227
Regional failure 74
Regional flap 324f
Regional lymph nodes 29, 100, 173
treatment of 100
Rehabilitation 242
Remodelling, stage of 241
Renal failure 7, 68, 133, 201, 214, 312, 317
Renal function tests 129
Renal stones 88, 289, 290
Respiratory
alkalosis 288
infection, upper 281
insufficiency 174
obstruction 260
rate 77
system 6, 42, 235
tract 47
Rest 64
pain 198, 202, 204
Resuscitation formulae 315t
Retention 101
cyst 104, 120
Reticulum cell sarcoma 137
Retinal damage 231
Retinopathy 214
Retromolar
intubation 234
trigone 143
Retroperitoneum 114
Retropharyngeal abscess 140, 141
Retrosternal goiter 121, 269, 287f
Revised National Tuberculosis Program 26
Rh group 65
Rhabdomyoma 300
Rhabdomysarcoma 300
Rhagades 137
Rheumatic fever 140, 141
Rheumatoid arthritis 11, 207, 208
Rhinitis 28, 29
Rhinorrhea 186, 253
Rhinoscopic mirror examination, posterior 178
Rhomboid glossitis, median 138
Rickets 240, 288
Riedel's thyroiditis 265, 280
Rifampicin 25, 26, 33, 34
Rigid laryngoscope 233
Ringer lactate 72
Rinne's test 191
Risus sardonicus 31, 32
Road traffic accidents 244
Robotic surgery 3
Rodent ulcer 40, 46
Root canal treatment 32
Root, resorption of 295f
Round cell infiltration 283
Rowe's disimpaction forceps 254f
Rubber bandage 357
Rubber catheter, plain 352
Rubber instruments 347
Rule of ten 259b
Ruptured thrombosed aneurysm 17
Rye's classification 128
Ryle's tube 81, 347, 347f, 348f
insertion, steps of 348f
lubricating tip of 348f
marks of 347
tip of 347t
S
Saccular aneurysm 111, 111f
Saddle nose 28, 29
Salivary
fistula 166
flow causes 168
Salivary gland 104, 156, 300
clinical examination of 168
diseases of 156, 157
examination 6
malignant tumors in 161t
tumor 161, 164, 167fc
benign mixed 361
treatment of 164
Salmon patch 108, 109
Salpingitis 29
Saphenofemoral junction 215
Saphenopopliteal junction 215
Saphenous nerve 215
Saphenous system, course of short 215f
Saphenous vein 217f
Saponification 85
Sarcoidosis 13, 160, 290, 291
Sarcoma 143, 162
Sarcomatous change 87
Sarcomatous odontomes 292, 295
Satellite nodules 99
Saucerization 305
Scaffolds 54, 174
Scalds 195
Scalenotomy 208
Scalenus anticus syndrome 207
Scalp 180
dry gangrene of 196f
laceration 180
moist gangrene of 197f
swelling/laceration 186
Scalpel blades 223f
Scar 227
Schizophrenia 188
Schwannoma 85
Schwartz test 217
Scissors 340
curved 340, 340f
Sclerotherapy 218
complications of 218b
indications of 218b
Sebaceous cyst 87, 104, 106, 107f, 107t, 108f, 121
Sebaceous horn 108, 108f
Seborrheic keratosis 83
Sedative hypnotics 232
Seddon classification 189
Segmental occlusive lesions 205
Seldinger's needle 201
Seldinger's technique 201
Senile osteoporosis 240
Senile warts 83
Sensory
and motor weakness 87
function 190
impairment 40
loss 166
Sentinel node biopsy 100
Sepsis 144
control of 214
uncontrolled 213
Septic shock 71, 73, 317
Septic ulceration 196
Septicemia 14, 19, 20
Sequestrectomy 305
Sequestrum 304
Serological tests 27
Seroma 47
Serotonin 9
Serous inflammation 11
Serum 40
creatinine 7
hepatitis
B 66
C 66
thyroid-stimulating hormone 263
Sexual contact 27, 40
Shock 10, 14, 70
monitoring of 72
pathophysiology of 70fc
treatment of 72
types of 70
warm 71
Sialadenitis 161
Sialocele 166
Sialography 168
Sialorrhea, causes 168
Sideropenic dysphagia 144, 145
Silver sulfadiazine 316b
Sinogram 40
Sinus 30, 37, 37f
acquired 37
anatomical 37
chronic 39
congenital 37
examination of 38
forceps 337, 337f
formation 293
margin of 40
of His 115
openings, multiple 39
Sistrunk's operation 283
Sistrunk's procedure 134
Sjögren's syndrome 161, 167, 167f, 169
Skeletal maturation, premature 296
Skeletal metastasis 276b
Skeletal muscles 300
Skeletal traction, continuous 242f
Skin 6, 14, 83, 104, 108
adherent 87
adhesive strips 332, 333f
atrophy 198
basal cell layer of 300
biopsy 33
care 134
changes 216
clips 333, 333f
color 81
discoloration 87
diseases 11
dry 266f
edges 333f
graft 318, 319, 319b, 320b
delayed 317
full thickness 319
loss, reasons of 319
types of 319fc
hook 340, 340f
incision 223
vertical 175f
infections 202
involvement 30
lesion 34
lubrication 202
malignant change 163f
necrosis of 15
overlying 168
pigmentation 56, 218
rash 29, 70
section of 313f
sloughing of 15, 151
smear 33
staples, application of 339f
substitutes 325, 326b
to skin transmission 32
ulceration 218
wrinkling of 33
Skull 180
depressed fracture of 181f
forms 6
fracture 181, 244
base of 193
Sleep apnea 141
Slipping sign 84, 87
Sloughed floor 40
Sloughed ulcer 214
Small lesion, excision biopsy of 309f
Smoke inhalation syndrome 317
Snail track ulcers 28
Snowstorm appearance 160
Snuffles 29
Soap-bubble appearance 297
Sodabicarb, bolus of 317
Sodium iodide 273
Soft tissues, cutting 227
Sole of foot, melanoma of 100
Soleus plexus 221
Solitary adenoma 289
Solitary bone cyst 104, 296
Solitary nodule 268
Solitary oral ulcer 137
Solitary thyroid nodule 266, 277fc, 279, 279b, 279f, 280fc
Sore spots, relief of 236
Sore throat 28
Sounds, abnormal 77
Southampton wound grading system 15
Speckled leukoplakia 144
Speech, restoration of 247
Sphenoidal sinusitis 188
Spica 355
Spina bifida 119
Spinal anesthesia 237
Spinal cord 87
compression, reversal of 230
injury 209
transection 231
Spine 42
Spiral fracture 240
Splanchnic vasoconstriction 71fc
Splenectomy 129
Splint 242
Split skin graft, harvesting of 321f
Split thickness 319
graft 319, 320
Sports injuries 244
Sprain 239
Spreading cellulitis 213f, 214
Squamous carcinoma, metastatic spread of 114
Squamous cell 83
carcinoma 40, 41f, 45, 46f, 143, 161, 172, 300, 301
low-grade 147
papilloma 83
Squint 114
Stamp graft 320, 322f
Staphylococcal infection 38
Staphylococcus aureus 15, 132, 188, 304
Starch iodine test 167
Steam inhalation 171
Stellwag's sign 283, 285f
Stem cell
therapy 54
transplant 131
Stenosis, chronic 174
Stensen's duct 156
Stereolithographic modeling 243
Sterilization methods of 59
Sternal tenderness 123
Sternomastoid
contracture of 114
muscle 113, 127, 191
tumor 113f, 121
Steroids 14, 30, 38, 52, 171, 291
Stomach
body of 347
leiomyoma of 299
pylorus of 347
Stomatitis 135, 168
gangrenous 137
Straight artery forceps 336f
Straight scissors 340
Strawberry angioma 109
Strawberry hemangioma 108, 109f
Streptococcus hemolyticus 320
Streptococcus pyogenes 132
Streptomycin 25, 26
Stress fracture 239
Stridor 19, 170
Struma ovarii 271
Stump neuroma 85, 86
Sturge-Weber syndrome 109
Subclavian artery 199
aneurysm 102, 121
poststenotic dilatation of 207f
without ischemia, occlusion of 208
Subclavian
vein, right 72f
vessels 17
Subcutaneous emphysema 77, 82
Subcutaneous fat, loss of 198
Subcutaneous infective gangrene 18
Subcutaneous tissue 104, 218
Subcuticular suturing 332, 333f
Subdural hematoma 184, 185f, 185t, 188f
Subfascial endoscopic perforator surgery 219
Subglottic area 170
Subhyoid
bursa 104, 121, 286
bursal cyst 119
bursitis 121
Sublingual dermoid 105, 106, 121
cyst 137, 158
ranula 121
Sublingual gland 156, 157, 161
Sublingual nerve 157
Submandibular
abscess 16f
gland 19, 156, 157, 159f, 161, 169
excision 159
left 158f
surgical anatomy of 157
tumor 164
tumor, left 164f
lymphadenopathy 159
region, swelling 159
sialadenitis 158, 159
triangle 121
tumor 159
Submental
lymph node 121
sinus 39
triangle 121
Submentotracheal intubation 234
Submucous fibrosis 137
Subperiosteal cellular proliferation, stage of 241
Subungual melanoma 100
Sucking chest wound 79
Suction drain, closed 225f
Sulfur granules 40, 41
Sunray' appearance 299f
Sunset foot sign 198f
Supraclavicular nodes 122
Suprafacial parotidectomy 165
Supraglottic
laryngeal pathology 178
tumors 174
Supraglottis 173
Supraomohyoid neck dissection 127
Suprasternal notch 286f
Supratentorial hemorrhage 184
Sural nerve 215, 218
Surgeon's hands 15
Surgeon's knot 330, 330f
Surgical instruments 15, 334
Surgical needles 327, 338
Surgical repair, aims of 259
Surgical sympathectomy 206
Suture materials 328
Suture removal, time of 225b
Suture, size of 328
Suturing instruments 338
Suturing techniques 330
Suturing, continuous 332f
Sweat glands, abscess of 30
Sweating 271
Swelling 8, 30, 101, 121t, 123, 168, 296
compressible 103
control of 134
diffuse 17
duration of 123
inflammatory 302
local 17
moving 286b
neck, midline 121t
progress of 123
similar 123
solid 112114
with slip sign, lobular 121
Swiss roll operation 134
Sympathectomy 197
chemical 205
Sympathomimetics 161
Syncope 70, 73
Synthesis, steps of 263
Synthetic biological dressing 316b
Syphilis 11, 13, 27, 42, 137, 139, 144, 171, 304
acquired 28
congenital 28, 29, 137
gummatous 28
latent 28
tertiary 28, 137
Syphilitic
chancre 140
glossitis 144, 145, 151
gumma 140
tongue 137
ulcer 40, 41, 45, 136, 139
Systemic infection 14
Systemic inflammatory response syndrome 14
Systemic lupus erythematosus 125
T
Tabes dorsalis 40, 240
Tachycardia 14, 79, 271
Taenia solium 119
Taper cut needle 328
Tarsal tunnel syndrome 86
T-cell lymphoma 130
Technetium sestamibi scan 290f
Teeth
broken 77
extraction of 236
lateral displacement of 293
malocclusion of 255
missing 6
surgical removal of 236
Tegaderm 43
Telemedicine 3
Teletherapy 229
Temperature
loss of 195
raised, local 17
Temporal artery, superficial 199, 325f
Temporal bone fracture 193
Temporomandibular joint
ankylosis of 255
arthritis of 32
examination 6
Tendon sheath 87
Tendon, repair of 64
Tennison technique 260
Tense cystic 119
swelling
containing gelatinous fluid 87
right cheek 119f
Tension pneumothorax 79
Teratomatous dermoid 106
Terazocin 206
Testes 231
Testicular tumors 230
Tetanus 31, 32, 174
head and neck of 32
latent 31
neonatorum 31
postoperative 31
prophylaxis 315
Tetany 289b
Tetraiodothyronine 264, 269, 279
Thallium-technetium subtraction isotope scan 290
Thermal injury 317
Thermocouples 60
Thermometers 61
Thiacetazone 25
Thigh claudication 198
Thiocyanates 263
Thiopentone 195, 208
Thompson procedure 134, 134f
Thoracic outlet syndrome 207
causes of 207b
Thoracoscopic surgery 2
Thoracotomy 81
Threatened airways 230
Three-dimensional plate 251f
Throbbing pain 17, 30
Thromboangiitis obliterans 204
Thrombocytopenia 68
Thromboelastography 67
Thromboendarterectomy 202
Thrombophlebitis 66, 204, 218, 219
superficial 222
suppurative 317
Thromboplastin time, activated partial 222
Thrombosis 201, 204, 204t, 221, 312
Thrush 35
Thumb reconstruction 325f
Thymoma 121
Thyroglossal
cyst 103, 104, 106, 121, 282, 284f, 286
fistula 38, 39, 116, 283, 284f
Thyroid 126, 240, 300
antibody 280
artery, inferior 282f
autoantibodies 265
cancer 274, 276b
treatment of 275
carcinoma 172, 274, 275b, 276t
descent of 283f
dysgenesis 266
examination, Pizillo's method of 286f
eye disease 283, 283b
failure 231
function tests 7, 263
gland 104, 262, 262f, 263f, 290f
blood supply of 263f
clinical examination of 284
smooth enlargement of 272f
hormones 263t, 266
incidentaloma 279, 279f
lingual 138, 282, 283f
lobectomy 361f
lower poles of 263f
neoplasms 273
nodule 287f
pathology 7
primary tumor 290
scan 277f
stimulating
antibodies 270
hormone 264, 269, 276, 278, 279
superior pole of 287f
surgery 172
swelling 121, 268f, 286
painless 281
tumors, malignant 274b
Thyroidectomy 226f, 281, 282f, 289f
complications of 281
endoscopic 2, 281
subtotal 268
Thyroiditis 265, 271, 279, 281t
granulomatous 280
subacute 265
Thyrotoxic crisis 282
Thyrotoxicosis 270, 271, 272, 273b, 273t, 290
factitia 271
primary 270, 271t
secondary 268, 270, 271t
symptoms of 285
Thyrotropin-releasing hormone 264
Thyroxine 271, 281
replacement 277
Tibial artery
continuation of anterior 199
posterior 199, 199f
Tibial nerve, posterior 33
Tic douloureux 191
Tidy wounds 47
Tip, location of 347
Tiredness 285
Tissue
adhesive glue 333f
biopsy 7
principles of 307
steps of 309
damage 9
ectopia of 101
edema 151
engineering 54
expansion 326
glue 333
holding forceps 335
movement, symmetry of soft 6
neck, X-ray soft 264
necrosis 8
normal 108
replacement, principles of 312, 318
sarcoma, soft 17, 130
soft 6
swelling middle face, soft 253
symmetry, soft 6
vaporization of soft 227
Titanium mesh 251
TNM
classification 148t
staging 99, 173t
Tobacco 144, 201
Toe amputation 206
Tongue 5, 6, 83, 135, 148
base of 126
bite during epilepsy 138
black 138
cancer 152
carcinoma 143f, 145, 146, 149, 153
tip of 143f
chancre of 28
congenital fissuring of 137
depressor 153f
deviation 31, 32, 143f
diseases of 137
fall 77
forceps 336, 336f
hairy leukoplakia of 35
inflammation of 8
inflammatory lesions of 138
inspection of 153f
laceration of 138
oral thrush 136f
posterior one-third of 28
protrusion 284f
tie 137, 153, 154f
tremors 271, 271f
ulcer 139
small 149f
Tonsil 6, 135
carcinoma 147, 151
diseases of 140
Tonsillar malignancy, suspected 141
Tonsillectomy 141
complications of 141, 177
Tonsillitis 114, 304
acute 32, 140
chronic 140, 141
recurrent 141
acute 141
Tooth
eruption, prevention of 293
extraction 68
sharp 137, 144
whitening procedures 227
Tooth-bearing segment, fracture of 249
Toothbrush injury 137
Toothed forceps 335, 335f
Torsion 104
Torticollis 113, 113f, 114
Total axial nodal irradiation 129
Total body surface area 315
Total leukocyte count 39
Total thyroidectomy 268, 276b
Tourniquet test, multiple 217, 217f
Touton giant cells 11
Toxemia 20, 29
Toxic
adenoma 270, 272, 273, 279
goiter 272t
diffuse 270
iodine-induced 271
multinodular goiter 265, 270
nodular goiter 273
Toxicity 231
Toxoplasmosis 125, 126
Trachea 174
extubation of 235
Tracheal deviation 5, 82
Tracheal dilator 345, 345f
Tracheal injury 177
Tracheal intubation 233
routes of 233
Tracheal lumen, normal 264f
Tracheal position 77
Tracheal stenosis 177
delayed 233
Tracheocutaneous fistula 177
Tracheoesophageal fistula 177
Tracheoinnominate artery fistula 177
Tracheomalacia 282
Tracheostomy 78, 171, 174, 175f, 234
aftercare of 176
aims of 174
instruments 344
tube 175f, 176f, 345
checking position of 176f
types of 174
Traction, continuous 242
Transconjunctival incision 254
Transfixation screws 242, 242f
Transfusion reaction 66
Transilluminant 121
swelling 120f
Transillumination test 102
steps of 102
Transitional cell 83
Transmetatarsal amputation 206, 214
Transmitted pulsation 102
Transosseous wiring 249
Transplant surgery 2
Transverse fracture 240
Transverse skin incision 177f
Trapezius muscle 191
Trauma 75, 77, 171, 174, 222
life support, advanced 76, 185
mechanical 40
recurrent 209
Traumatic fracture 239
Traumatic gangrene 209
indirect 210b
Traumatic ulcer 40, 43, 220
tongue 43f
Tremor 271, 285
Trench foot 195, 210
Trendelenburg position 64, 73, 74
Trendelenburg procedure 219
Trendelenburg test 217, 217f
Treponema pallidum 27
hemagglutination test 28
immobilization test 28
Triangle group, posterior 123
Triangle swelling, anterior 121
Trigeminal nerve 190
divisions of 191f
root, microvascular decompression of 192
Trigeminal neuralgia 191
Trigeminal root section 192
Triiodothyronine 264, 279
Trismus 31
treatment of 236
Trocar 342f
Trochlear nerve paralysis 190
Troisier's sign 122
Trophic changes 198, 198b, 208
Trophic ulcer 40, 45, 209
Trousseau's sign 289
True aneurysm 111
True neuromas 85, 86fc
Trypsin 12
Tube
accidental dislodgement of 177
blockage of 233
disconnection of 233
drain 346
kinking of 233
replacement of 177
Tubercular infection 38
discharge for 42
Tubercular lymphadenitis 124
Tubercular osteomyelitis 305
Tubercular sinus 37, 39
scars of 24f
Tubercular ulcer 40, 41, 43, 45, 45f, 136, 139
Tuberculoid leprosy 33, 34, 34t
Tuberculosis 11, 13, 22, 23, 26t, 35, 3841, 124, 137, 139, 160, 174, 290, 304
abscess formation, pathogenesis of 23fc
head and neck manifestations of 24
intestinal 23
Tuberculous lymphadenitis 22, 125, 359, 360
Tubular bones 239
Tubuloembryonic dermoid 106
Tumescent anesthesia 219
Tumor 8, 83, 148, 174, 193
benign 83, 83t, 84, 172, 178, 240, 273
disseminated 240
giant cells 11
in salivary glands, benign 161t
infection of 304
invasion, Clark's level of 99, 99f
malignant 83, 83t, 172, 179, 240, 273, 302
necrosis factor 10, 11
primary 127, 148, 290
spillage, significant 166
thickness 99
treatment of primary 149
types of malignant 274
Two glass urine test 29
Typhoid 21
U
Ulcer 37, 40, 41f, 43, 218
causes, nonspecific 40
chronic nonspecific 139
clinical examination of 40
floor of 41f
gummatous 45, 139
herpetic 136
infective 40, 220
life history of 40
malignant 40, 41, 43, 46f, 136, 139, 220
multiple 35
nonspecific 40
painless 28
perforating 40
specific 40
Ulceration 204
ischemic 202
Ulcerative stomatitis 136
Ulnar nerve 33
Ultrasonography 279
Umbilical sepsis 31
Unilateral recurrent laryngeal palsy 171
Unilocular cavitation mandible 296f
Untidy wounds 47
Uremia 14, 52, 351
Urethral
catheterization 350
injury 351
smears, gram staining of 29
stricture 29
Urinary
bladder 83
catheterization of 73
catheter 81
fistula 38
infection 351
meatus, external 351f
Urine 38, 39
examination 7
output 72
Uterus 216, 230
Uvula 6
V
Vacuum-assisted biopsy 308
Vagus nerve 191
Vallecula 126
Valsalva maneuver 119
Valvular defects 42
Van der Woude syndrome 261
Varicocele 216
Varicose ulcer 40, 43, 219
treatment of 220
Varicose veins 40, 43, 44, 42, 215, 216, 216b, 216t, 217f, 218, 220, 222
bilateral 220f
complications of 218b, 219
long standing 40
Varicosities 216b
Vascular disease 201
peripheral 213, 214
Vascular injury, major 218
Vascular symptoms 207
Vasoactive amines 9
Vasoconstriction 9
Vasopressors 73, 207
Vasospastic disorders 206
Vasovagal syncope 73
Vault, depressed fracture of 182f
Vein thrombosis 133, 195, 215, 218, 221, 221f
Velocardiofacial syndrome 261
Vena cava obstruction, superior 230
Venereal disease research laboratory 28
Venesection
cannula 347, 349f
steps of 349f
Venography 218
Venous
angioma 110
cut down, indications of 347
drainage 262
gangrene 208, 222
hemorrhage 62
hypertension 220fc
insufficiency, chronic 222
obstruction 195
pressure monitoring, central 72
refilling 199
sinuses 181
system, diseases of 215
ulcer 40, 44, 44f, 44t, 220, 222
chronic 46f
Verruca vulgaris 83
Verrucous carcinoma 147
Vertebral artery aneurysm 121
Vessels 47
Vestibular incision 254
Vestibuloplasty 227
Vicryl 328
sutures, interrupted 53f
Video-assisted surgery 243
Vincent's angina 21, 136, 137
Vincent's organisms 45
Viral infection 34, 140, 159, 172, 281
Virchow's lymph nodes 122
Virchow's triad 221
Virtual reconstruction 243
Virus 8
Viscera, abdominal 195
Visual disturbance 187
Vitamin
B6 deficiency 257
D
deficiency 288
intoxication 290
K deficiency 67
supplement 136
Vocal cord 172f
palsy 171
etiology of 172t
polyp 171
Voice abuse 171
Voice quality 77
Voice, hoarseness of 268, 285
Volkmann's scoop 344, 344f
Vomiting 66, 70, 77
von Graefe's sign 283
von Recklinghausen's disease 87, 88
von Willebrand's disease 69
W
Waldeyer's lymphatic ring 122, 122f, 128, 130
Wallace rule of nine 314, 318f
Wallerian degeneration 189
Walsham's forceps 248, 248f
Warm nodule 264
Warthin's tumor 161163, 163f, 163t
Waste disposal 59f
Watery discharge 41
Wearing gown, method of 58f
Weber Ferguson incision 302f
Weber's test 191
Wedge biopsy 42, 309f
Wegner's granulamatois 137
Well's arterial clamp 338, 338f
White cell trapping 220
Wound 31, 47
classification of surgical 47t
closure 224
faulty 52
crushed 48, 50
debridement 18, 243
dressing 353
regular 42
steps of 354f
examination of 52
excision 53f
healing 50, 52f
acute 51f
adverse factors for 52t
burns 314
complications of 55
phases of 51
hematoma 52
infection 14, 52, 55, 177, 218, 282
deep 15
severe 15
left 149f
leg, infected 54f
management, types of 48t
medicolegal aspects of 54
perforating 49
punctured 48, 49
secondary bacterial infection of 40
treatment of 52
types of 47, 48, 48t
Wry neck 113
Wuchereria bancrofti 132
X
Xerostomia 151, 231
causes 167
Xylocaine spray 155
Y
Yellow sulfur granules 38
Z
Ziehl-Neelsen stain 24, 40
Zygomatic arch 244
fracture 245f, 246f
Zygomatic complex, fracture of 245, 246
Zygomatic fracture, reduction of 247f
×
Chapter Notes

Save Clear


Introduction of SurgeryChapter 1

Sanjay Marwah
 
HISTORY OF SURGERY
There have been evidences that the art and craft of surgery was developed even during prehistoric cultures.
 
Ancient Period
  • The human remains of Neolithic times and cave paintings show holes drilled into the skull exposing the dura mater to treat intracranial diseases.
  • Early Harappan periods of Indus Valley Civilization (modern day Pakistan) show evidence of teeth being drilled during 3300 BC.
  • In ancient Egypt, a mandible shows two perforations just below the root of first molar indicating drainage of tooth abscess during 2650 BC.
  • Sushruta was well-known Indian physician who taught and practiced surgery on the banks of Ganges during 600 BC. He wrote volumes of surgical textbooks (Susrutha Samhita) and is known as Father of Surgery. His books described method of examination, diagnosis, treatment and prognosis of various illnesses. He also described detailed operative techniques of plastic and cosmetic surgery.
  • In ancient Greece, Hippocrates was the Greek physician who innovated the famous Hippocratic Oath.
  • In ancient China, Hua Huo was a famous Chinese physician who was the first to perform surgery with the help of anesthesia.
 
Medieval Period
  • In middle ages, surgery was developed in the Islamic world. Abulcasis was a great medieval surgeon who wrote comprehensive textbooks and is often regarded as Father of Surgery.
  • In Europe, the surgery became a formal subject and got split away from medicine in 15th century. Rogerius Salernitanus composed the modern surgical manual (Chirurgia) that continued up to modern times. In 19th century, degree of bachelor of surgery (ChB) began to be awarded with bachelor of medicine (MB) that later became MBBS. The master degree became the higher degree and was awarded as master of surgery (MS).
  • During World Wars, the battlefield doctors became surgeons by pioneering the treatment of gunshot wounds. Naval surgeons were often barbers doing surgery as an additional job.
 
Modern Age
The modern surgery progressed at a rapid pace based on three developments:
  1. Control of bleeding: Before modern surgery developed, there was a real threat of patient bleeding to death during operation. Wound cautery with extreme heat was tried as an effort to control bleeding. But it was destructive, painful and had poor outcome. Concept of ligating the bleeding vessels was given by Abulcasis in 10th century that was much better than cautery. But it was also very dangerous because of high rate of infection caused by ligatures. Later the results of ligatures improved once the concept of infection control came in. In early 20th century, concept of blood grouping allowed effective blood transfusion.
  2. Control of infection: The concept of infection control was unknown till early modern times. In 1847, Hungarian doctor Ignaz Semmelweis noticed that medical students coming from dissection hall were causing excessive maternal death compared to midwives. He introduced compulsory handwashing for everyone entering the maternal wards leading to significant decrease in maternal and fetal death. However, his advice was dismissed by Royal Society in UK.
    Later, Joseph Lister, a British surgeon, started using phenol during surgery to prevent infection that quickly reduced the infection rate. He also introduced techniques of instrument sterilization, rigorous handwashing and rubber gloves for surgical procedures. He published his 2work in The Lancet in 1867 and he was named Father of Antiseptic Surgery.
  3. Control of pain: In earlier times, surgery was traumatic and very painful procedure. Control of pain or anesthesia was first discovered by two American Dental Surgeons, Horace Wells (1815–1848) and William Morton. With discovery of anesthetic chemicals (ether and chloroform), surgical practice changed dramatically. Later, discovery of muscle relaxants (curare) allowed prolonged and complex surgeries to be performed effectively.
 
RECENT ADVANCES
Consequently, other developments that led to the progress of modern day surgery are:
  • Development of imaging techniques, like ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan.
    • Ultrasound: These are high-frequency waves that are transmitted in beams and are used to scan the body tissues. Different tissues alter the waves in different ways, some reflect while others scatter them. The reflected waves return back to the transducer as echoes and are converted to electrical signals that are displayed on a video monitor. Its advantages are that it is a painless, noninvasive, relatively inexpensive outdoor procedure that does not use any radiations.
    • Computed tomography scan: An X-ray tube rotates around the patient who is placed in the center of the scanner. It gives three-dimensional image of the body and delineates various body structures from each other and demonstrates their relationship.
    • Magnetic resonance imaging: The patient is placed in a powerful magnetic field with which the protons within the body become aligned. Radiowaves in the form of a radiofrequency pulse transmitted into the patient cause the alignment of the protons to change (e.g. by 90°). When this radiofrequency pulse in turned off, the protons in the patient's body return to their neutral position, emitting their own weak radiosignals which are detected by receiver coils and used to produce an image using powerful computers. The contrast resolution of MRI is 100 times better than CT scan and it does not use any radiations.
    • Positron emission tomography scan: PET is a functional imaging modality that detects the disease process in its early phase as metabolic abnormalities that generally precede anatomical changes. It allows imaging of whole body and is valuable in detection of metastatic cancer. F-18 fluoro-2-deoxy-D-glucose is commonly used positron emitting radiopharmaceutical used for PET imaging. Aim is to assess metabolic functions such as oxygen and glucose consumption and blood flow.
  • Microvascular and reconstructive surgery: It is aimed at reattachment of severed limbs, digits, or other body parts by plastic surgeons. Modern techniques such as the use of a bone grinder to assist in grafting bone back into place are becoming more common.
  • Transplant surgery: In case some vital organ is damaged by disease process (kidney, liver), it is removed and replaced by the same organ retrieved from the human donor (live or cadaver). It involves complex microvascular procedures. Since transplanted organ is a foreign element to the body, it is likely to be rejected by autoimmune response. Its rejection is prevented by use of immunosuppressive drugs. Once the transplant is taken up, the patient is able to lead near normal life.
  • Development of minimal access surgery: It is a technique that helps in performing surgical procedures with less invasion, less disfigurement, less postoperative pain and early recovery of the patient. With increasing experience, surgeons are becoming experts in performing major surgical procedures with minimal access surgery.
Various minimal access techniques are:
  • Laparoscopic surgery: The peritoneal cavity is inflated with carbon dioxide to produce pneumoperitoneum. A telescope is then introduced to visualize the inside of peritoneal cavity by projecting the image on a television screen (video-assisted surgery). Various instruments are then introduced into peritoneal cavity through various ports in abdominal wall to perform the surgical procedures, e.g. laparoscopic cholecystectomy, hernia repair.
  • Thoracoscopic surgery: The thoracic cavity is entered in the same way (as laparoscopy) to perform various procedures in the thoracic cavity.
  • Endoscopy: Flexible tubes are introduced into hollow organs (esophagus, colon, urinary bladder) through natural orifices for visualization of internal pathologies and their management. ENT surgeons perform minimal access surgery on ear and paranasal sinuses using small flexible endoscopes.
  • Arthroscopy: Visualization of inside of joint spaces, e.g. knee joint.
  • Endoscopic brain surgery: Flexible endoscope and fine instruments are introduced into cranial cavity through small holes in the skull to perform surgery on intracranial lesions.
  • Endoscopic thyroidectomy: Small incisions are made on the chest wall, and thyroidectomy is done using laparoscopic instruments. Its advantage is that it avoids neck scar and is cosmetically better in young females.
  • Natural orifice transluminal endoscopic surgery: In this new concept meant for avoiding skin incision for surgery, a flexible endoscope is introduced through natural orifices (oral cavity, anal canal, vagina, etc.).3 Then an abdominal viscus (stomach, rectum, etc.) is transgressed to enter into peritoneal cavity. With the help of video-assisted surgery, operation is performed, e.g. appendicectomy or cholecystectomy and the specimen is removed through the viscus (e.g. stomach).
  • Robotic surgery: In place of surgeon's hands, robot is used for performing a surgical procedure. The surgeon sits on a computer console and gives command to the robot for performing various surgical steps. Its advantages are:
    • The movements are precise and free from tremors giving high accuracy in sensitive areas.
    • Dexterity of movements, i.e. unlike human hands, the robot can move the instruments up to 360.
It helps in performing surgical procedures in great depth even when space for the movements is restricted.
  • Telemedicine: With use of Internet in medical sciences, it has further improved surgical teaching and training. The surgical procedure performed at one place can be telecast live at any other place through video conferencing while operating surgeon interacts with the audience. This technique is becoming very popular and is being widely used in live operative workshops meant for training young surgeons.
  • Newer energy sources: Apart from use of high-quality electrocautery (monopolar or bipolar), newer energy sources have been devised for precise tissue cutting as well as coagulation, e.g. lasers, high-frequency ultrasonic waves, harmonic scalpel, etc. (see Chapter 20). These energy sources have made the minimal access endoscopic surgery very safe and simple.
 
DEALING WITH A SURGICAL PATIENT
Out of all medical disciplines, surgery is a unique specialty where surgeon, who is primarily a doctor, treats the disease using surgical instruments.
The stages through which a surgical patient passes are described as surgical crescendo. These are:
  • History taking
  • Clinical examination
  • Making clinical diagnosis and keeping possibilities of various differential diagnoses
  • Investigations
  • Making final diagnosis
  • Surgery
  • Sometimes diagnosis is still not made even after exploration. In such situation, either nature cures the disease and diagnosis is never made or the patient dies and postmortem reveals the exact pathology.
A surgical patient coming to the hospital can be:
  • Elective case
  • Emergency case.
zoom view
Flowchart 1: Outlines of management of elective surgical case
Elective case reports in the surgical outdoor during routine hours where diagnosis of disease is made. Then he is admitted in indoor and operation is performed (Flowchart 1).
Emergency case reports in the casualty at any time and is managed in a different way. After quick history and examination, resuscitation is started.
Performing investigations and reaching the final diagnosis is considered only after the patient is stabilized. If patient remains unstable despite resuscitation, then emergency surgery is planned (Flowchart 2).
It is very important to do repeated clinical examination in emergency because it helps in delineating the ongoing changes and reaching the diagnosis.
Thus, it is apparent that actual operation is only a part of total surgical care. Equally important are making diagnosis, preoperative build up and postoperative management. If diagnosis is incorrect, it may lead to improper surgery and patient may not have any benefit from it.4
zoom view
Flowchart 2: Outlines of management of emergency surgical case
Inadequate preoperative build up can lead to intraoperative and postoperative complications and mortality. Similarly, lack of postoperative care can lead to serious postoperative complications like hypostatic pneumonia, deep vein thrombosis, wound sepsis, etc.
 
HISTORY TAKING
History taken in outdoor or emergency relates to the specific complaints of patient so as to reach the diagnosis.
On the other hand, history taken in the indoor for admitted patient has two objectives:
  1. To reach the clinical diagnosis
  2. To look for fitness of patient for surgery.
“Symptoms” are the complaints told by the patient while “signs” are the features seen by the clinician on clinical examination.
Before asking “symptoms”, background of the patient is recorded that includes:
  • Name
  • Age
  • Sex
  • Marital status
  • Occupation
  • Address.
Then symptoms are asked and recorded preferably in patients own words and in “chronological order” of their appearance.
 
History of Present Illness
Duration of illness: It is very important to ask “When were you perfectly well before the present illness”? The patient is likely to tell about mild episodes of similar illness in the past which otherwise he may ignore to mention. However, in reality, it may be of great importance in making the diagnosis.
Mode of onset: How the illness started, e.g. a swelling appearing on scalp after trauma is likely to be a hematoma.
Progress: Whether illness is improving or worsening, e.g. an inflammatory pathology is likely to improve with analgesics and anti-inflammatory drugs.
Aggravating and relieving factors: For example, an inflammatory pathology is likely to be aggravated with movement of the part and relieved with rest and analgesics.
Constitutional symptoms: These are those which occur secondary to the illness, e.g. pain, fever, cough, nausea, vomiting, weight loss, anorexia.
Past history: Any illness suffered in the past is recorded in chronological order. It may or may not be related to present illness. Past dental history is asked that includes history of dental extraction, scaling, root canal treatment, any implants or prosthetic appliances.
Personal history: Smoking, dietary habits, alcoholism are enquired. Marital status of the patient is asked and if married, number of children and their health is recorded. If some child has died, age and cause of death is noted.
Menstrual history: It is asked in female patients. Age at menarche, any menstrual irregularity, vaginal discharge, age at menopause, postmenopausal bleeding, etc. are recorded.
Family history: Whether any family member has suffered from similar illness. It can help in finding out genetic disorders (hemophilia) and communicable diseases (tuberculosis).
Treatment history: Any treatment taken and its effect on illness may help in reaching the diagnosis, e.g. a neck swelling improved with tablet eltroxin will suggest goiter. Any history of drug allergy and previous operations is also recorded.
 
EXAMINATION
 
General Physical Examination
Make the patient sit or lie in the bed comfortably.
Examine the patient with warm hands.
Look for:
  • General appearance, viz.
    • Level of consciousness (decreased in head injury).
    • Patient cooperative or uncooperative.
    • Patient anxious or lying comfortably in bed.5
zoom view
Fig. 1: Pigeon chest deformity
zoom view
Fig. 2: Jaundice seen in upper sclera
zoom view
Fig. 3: Jaundice seen on undersurface of tongue
zoom view
Fig. 4: Finger clubbing
zoom view
Fig. 5: Platonychia—flat nails
  • Build (assessed by skeletal framework). Skeletal deformities may be seen on exposure (Fig. 1).
  • Nourishment (assessed by triceps skin fold thickness, subcutaneous fat, skin texture, muscle mass).
  • Pulse rate (normal 72/min), regularity, volume.
  • Blood pressure (normal 120/80 mm Hg).
  • Temperature (normal 37°C).
  • Respiratory rate (normal 12–16/min), regularity, type (abdominal or thoracic).
    Look for various clinical signs from head to toe:
    • Anemia in palpebral conjunctiva, nail beds, tongue (areas rich in capillaries).
    • Jaundice in upper sclera, under surface of tongue, palmar creases (these areas are rich in connective tissue and bilirubin has great affinity for such areas) (Figs 2 and 3).
    • Cyanosis: Bluish discoloration of tongue (central cyanosis), bluish discoloration of tip of nose, fingers (peripheral cyanosis).
    • Clubbing: Drumstick appearance of fingers and toes (Fig. 4).
    • Platonychia: Flat nails seen in iron deficiency anemia (Fig. 5).
    • Tracheal deviation: Normally, trachea is centrally placed in suprasternal notch.6
    • Edema feet: Apply pressure with thumb for 10–15 seconds on the shin or ankle. Sign is positive if pit is produced at the site of pressure and remains for more than 30 seconds (Fig. 6). Edema gives rise to soft pitting while if pus is present, induration is always felt.
zoom view
Fig. 6: Demonstrating pitting edema at ankle
 
Local Examination
  • Side of the lesion (right or left) should always be recorded carefully.
  • A few simple instruments are necessary as “armamentarium” during patient examination. There are:
    • Pocket torch
    • Black paper
    • Tongue depressor
    • Metal scale
    • Measuring tape
    • Hammer
    • Stethoscope
    • Disposable gloves
    • Thermometer
    • Skin marking pen
  • While examining a lesion, be particular in noting its site, external appearance, possible anatomical organ of origin and its effects on surrounding structures.
  • The lesion may present as swelling, ulcer, sinus or fistula. Their details of examination are described in the relevant sections.
  • Always examine the lymph nodes draining the site of lesion.
 
Local Examination for Orodental Diseases
 
Extraoral examination
Inspection
  • Facial symmetry
    • Soft tissue symmetry: Facial asymmetry may be seen in soft tissue lesions such as nevus (see Chapter 11, Fig. 7 and 8B), hemangioma (see Chapter 12, Fig. 14).
    • Symmetry of soft tissue movement: It is used for assessment of motor functions of cranial nerves, e.g.
      • Movement of facial muscles: Facial nerve.
      • Ocular muscle movement: 3rd, 4th and 6th cranial nerves.
    • Symmetry of hard tissue movement: It is assessed by opening and closing of mouth.
  • Facial profile and facial proportions
  • Skull forms
  • Skin and soft tissues: Eyes, ears, nose, lips.
Palpation
  • Temporomandibular joint examination
  • Lymph node examination
  • Salivary gland examination.
 
Intraoral examination
  • Jaw movement and mouth opening
  • Teeth (number, size, color, caries, missing teeth, occlusion)
  • Gingiva (size, shape, color, ulceration, growth)
  • Alveolar mucosa
  • Labial mucosa
  • Bucccal mucosa
  • Palate (soft and hard palate) and fauces (tonsils)
  • Uvula, posterior pharyngeal wall
  • Tongue
  • Floor of mouth.
 
Systemic examination
The aim is to know the patient as a whole. During this, some other pathology related or unrelated to presenting disease may be discovered.
Various systems examined are:
  • Cardiovascular system
  • Central nervous system
  • Respiratory system (chest)
  • Gastrointestinal tract (abdomen)
  • Genitourinary system.7
 
Clinical Diagnosis
On the basis of history and examination, a clinical diagnosis is made. Aim is to localize the organ of origin, type of pathological process and its extent.
Pathological diseases are broadly classified as:
  • Congenital
  • Inflammatory (acute or chronic)
  • Neoplastic (benign or malignant)
  • Traumatic.
Other rare ones are:
  • Degenerative diseases
  • Metabolic diseases
  • Hormonal diseases.
In case, the diagnosis is doubtful, other possibilities are kept as differential diagnosis, starting with most probable diagnosis as first. Based on “law of probability”, commonly seen disease should be kept as first possibility.
 
INVESTIGATIONS
Aims of doing investigations are:
  • To reach final diagnosis
  • To look for fitness for anesthesia and surgery
  • In case of malignancy, staging of disease so as to plan treatment and assess prognosis.
Various investigations are decided according to the site and nature of pathology. These are:
  • Hematological investigations
    • Hemoglobin—for anemia
    • Bleeding time, clotting time—for bleeding disorders
    • Total and differential leukocyte count—raised in infections
    • Erythrocyte sedimentation rate—raised in chronic infections
    • Blood sugar—raised in diabetes
    • Blood urea and serum creatinine—raised in renal failure
    • Thyroid function tests—in case of thyroid pathology
    • Liver function tests—deranged in liver dysfunction.
  • Urine examination: For albumin, sugar and microscopy.
  • Stool examination: For ova, cyst, pus cells, occult blood.
 
Imaging
  • X-ray—for bony changes and fractures
  • Ultrasound—differentiates solid and cystic lesions
  • Doppler imaging—for blood flow
  • CT scan with contrast enhancement—for solid organs
  • MRI—for joints and spine.
 
Pathological Examination
  • Fine-needle aspiration cytology
  • Tissue biopsy
  • USG/CT-guided biopsy—helpful in localizing the site of lesion especially if it is deep seated.
 
MANAGEMENT OF UNFIT PATIENT
  • The patient should be hospitalized and built up for surgery.
  • In case of severe anemia, fresh blood transfusions are given to improve hemoglobin. The patient should have hemoglobin level of 10 g% at the time of surgery.
  • In case of severe hypoproteinemia (serum albumin less than 2 g%), parenteral nutrition should be given.
  • In uncontrolled diabetes, insulin injections are given.
  • In patients with chronic lung disease, preoperative preparation helps in preventing postoperative respiratory complications. Measures taken are:
    • Smoking cessation
    • Chest physiotherapy
    • Bronchodilators
    • Antibiotics (for purulent sputum)
  • Uncontrolled hypertension is treated with antihypertensive drugs.
 
RISK ASSESSMENT OF THE SURGERY
Before subjecting the patient to surgery, always put following questions to yourself:
  • What is the risk of surgery?
  • Whether patient will benefit from the operation?
Based on risk-benefit ratio, the patient should be counseled and written consent should be obtained from him before performing the operation.