Difference between Operability and Resectability

Difference between Operability and Resectability

Operability is with regard to the patient. If a malignant disease can be cured with a radical surgery, such a patient is said to be operable.

If one can not cure a malignant disease by a surgical procedure, it is called inoperable.

 It must be remembered that an inoperable disease may still be resectable, but that is not going to offer a cure !

An Example of Inoperability:- Carcinoma stomach with metastatic supra clavicular node  is considered as inoperable case. But the lesion may be locally resectable.

Resectability is with regard to the tumour. A lesion or tumour is said to be unresectable if it infiltrates the major vessels or nerves.

Unresectability doesnot mean that the case is inoperable. A vascular / nerve graft can be done after the excision of the unresectable tumour along with the adherent structures.

Impacted foreign body~ Never Pull Out!

Impacted foreign body ~ Never Pull Out!

Whenever  you come across an impacted foreign body like this, never try to pull out at the site of event.

Immediately rush the patient to a hospital where facility for emergency surgery is present.

Such a foreign body is removed only inside an operation theatre under the guidance of a surgeon, after proper investigations.

If such a foreign body is removed at the site of event, the patient may die even before reaching a hospital!

Endoscopic Thyroidectomy ~ Axilliary approach

Endoscopic Thyroidectomy ~ Axilliary approach

Endoscopic Thyroidectomy is performed through the ports inserted from the axilla.

Hence the major advantage of  Endoscopic Thyroidectomy is that there will be no scar in the neck.

Major disadvantage of the procedure is that it demands  a steep learning curve from the part of the surgeon.

The procedure requires specialized instruments.

         This procedure is not ideal for very large thyroids.

         Courtesy- Dr S K Ajaiyakumar, MCH,Trivandrum.

Clinical Pleomorphism ~ Tuberculosis

Clinical Pleomorphism ~ Tuberculosis

Extra Pulmonary Tuberculosis can manifest in a variety of clinical presentations.

It can present as a single cervical lymph nodular enlargement.

It can present as multiple discrete cervical lymph nodular enlargement.

It can present as multiple matted cervical lymph nodular enlargement.

It can present as matted lymph nodular enlargement with either uniform or variable consistency.

It can present as a cold abscess.

It can present as a collar stud abscess.

It can present as multiple sinuses in neck.

Hence tuberculosis is said to exhibit Clinical Pleomorphism.

Tubercle of Zuckerkandl, Thyroid Gland

Tubercle of Zuckerkandl, Thyroid Gland

Tubercle of Zuckerkandl, Arrow

 

Tubercle of Zuckerkandl is the posterior extension of the lateral lobe of Thyroid gland.

It can be used to identify the Recurrent Laryngeal Nerve.

The tubercle of Zuckerkandl points towards the Recurrent Laryngeal Nerve, during thyroidectomy, as shown.

Circumcision-Indications and Operative Surgery Steps

Circumcision

Circumcision is An Operative procedure

                           -which reduces the chance of Ca Penis

                           -which reduces the risk of transmission of HIV

Indications:

                  1.True Phimosis( due to Balonitis Xerotica Obliterans-BXO-Lichen Sclerosis – Sclerosing Inlfammatory Dermatosis- resultinfg in scarring of prepuce & prepuceal aperture becomes tight )

                   Physiological adhesion between the fore skin and the glans penispersist until 6 years of age 

                2.Paraphimosis( Failure of retracted foreskin to return to its original position over glans penis)

               3.Religious ( Most common)

              4.Recurrent balanoposthitis( Diabetes)

              5.Prior to Radiotherapy for Ca Penis

Anesthesia: Local / General

Position of the Patient: Supine

Incision:

                  Prepuce is divided in the midline dorsally up to corona &  the incision is extended circumferentially across the prepuce  5 mm beyond and parallel to corona.

Step 1. Three artery forceps are applied at 2, 6 & 10’ O clock position.

Step 2. Adhesion between prepuce and glans are released up to corona.

Step 3. Between the artery forceps at 2 and 10’ O clock position the prepuce is incised at 12’ O clock position up to corona.

Step 4. The outer skin and inner skin over the glans are cut all around anddivided parallel to corona leaving a ‘ v ’ shaped flap at the frenulum.

Step 5. A figure of 8 suture is placed over the frenulum ( As it contain the Arteryof Frenulum)

Step 6. Inner skin is sutured to the outer skin of prepuce with 2 0 absorbable interrupted sutures. 0.5Cm Inner skin has to be there to prevent the disfigurement

Branches of Facial Nerve Identification In Parotidectomy

Branches of Facial Nerve

Branches of Facial Nerve

There are Five Branches of Facial Nerve.

These five branches are located in the Facio Venous Plane of Patey.

Tragal Pointer- (Triangular Tragal Cartilage) helps to identify the Facial Nerve as it emerges from the Stylo Mastoid Foramen.

The Five branches are-

1.     Temporal

2.     Zygomatic

3.     Buccal

4.     Marginal Mandibular

5.     Cervical

Two most important branches of Facial Nerve are Zygomatic and Marginal Mandibular. 

If Zygomatic  branch is damaged it produces  inability to close the eyelid .

If Marginal Mandibular  branch is damaged it produces  Deviation of angle of Mouth.

Because of these two important cosmetic effects the above mentioned branches of the facial nerve are considered as the most important .

Hence if any one of these branches are accidentally cut, has to be repaired with Nerve Cable Graft.

The nerves used for cable graft are Sural Nerve and Great Auricular Nerve.