Nothing Special   »   [go: up one dir, main page]
Scribd Logo
Upload

Welcome to Scribd!

  • 64 views

    Aakash Neet PG Notes

    Uploaded by

    Aravindh Balaji S

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Aakash Neet PG Notes

    Uploaded by

    Aravindh Balaji S
    64 views6 pages

    Original Title

    aakash neet pg notes

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    64 views6 pages

    Aakash Neet PG Notes

    Uploaded by

    Aravindh Balaji S

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    LMR SURGERY – THORAX, LUNGS, ORAL CAVITY & SALIVARY GLAND

    THORAX AND LUNGS

    PNEUMOTHORAX

    • Defined as accumulation of air or gas in the pleural space


    • Causes:

    1. Trauma : blunt or penetrating injury to the Chest wall


    2. Iatrogenic : occurs due to a medical intervention, like central line insertion
    3. Primary : spontaneous: without any underlying lung disease
    4. Secondary : spontaneous: underlying lung disease is present
    5. Catamenial : occurs in women in conjunction with their menstrual period the cause
    is believed to be endometriosis of the pleura
    • Management:

    ✓ Asymptomatic: kept under observation; follow up with repeat X rays especially in a


    poly trauma case
    ✓ In traumatic pneumothorax with either stable or unstable vital signs require the
    insertion of Chest tube
    ✓ Most can be treated with small bore pigtail catheters, very large pneumothoraxes may
    require treatment with large bore chest tubes
    ✓ In concomitant hemothorax, a thoracostomy with a large bore chest tube insertion is
    necessary

    TENSION PNEUMOTHORAX:

    • Occurs when air flows into the pleural cavity during inhalation but is retained in the
    pleural cavity during exhalation & cannot exit; a gradual increase in intra-pleural cavity
    pressure
    • Results in complete collapse of the lung, mediastinum displaced to the other side;
    decreased venous return & compression of the opposite lung.
    • Symptoms : Chest pain(MC), air hunger, respiratory distress

    ©Aakash EduTech Private Limited | Visit us at pgplus.aakashdigital.com | Contact us: 011-40705055


    • Signs: Tachycardia, hypotension, tracheal deviation, U/l absence of breath sounds, neck vein
    distension & cyanosis

    • Management:

    ✓ Immediate decompression via needle thoracocentesis (done by the insertion of a large


    caliber needle into second intercostal space in midclavicular line)
    ✓ Definitive treatment is the insertion of a chest tube into the fifth intercostal space
    just anterior to the midaxillary line

    MEDIASTINAL TUMORS:

    THYMOMA:

    • MC seen in anterior mediastinum; 40-60 y


    • 10-50% cases are associated with Myasthenia gravis
    • Thymectomy improves 25%-30% of patients with Myasthenia gravis
    • 5-10% of thymomas - paraneoplastic syndrome like SLE, Red cell aplasia and Myasthenia
    gravis.
    • Masaoka Staging is used for classification
    • Definitive management is complete surgical resection
    • Radiotherapy is given for Stage II and above
    • Advanced /Large thymomas responsive to platinum based chemotherapy

    Lymphoma:

    • MC malignancy of the mediastinum; MC location: Anterior mediastinum; Highly invasive


    • Mediastinum: one of the primary sites in many Hodgkin’s and Non-Hodgkin’s lymphomas
    • Treatment: CHOP-R regime: Cyclophosphamide, Adriamycin, vincristine, Prednisone and
    Rituximab (CD 20 antibody)

    ©Aakash EduTech Private Limited | Visit us at pgplus.aakashdigital.com | Contact us: 011-40705055


    ORAL CAVITY AND SALIVARY GLANDS

    • Precancerous lesions: oral leukoplakia, oral erythroplakia, oral submucous fibrosis &

    lichen planus

    LEUCOPLAKIA (MC)

    • White keratotic plaque; cannot be rubbed off

    • Confirmed by mucosal biopsy -hyperkeratosis, acanthosis and dysplasia

    • Risk factors of malignant transformation:

    ▪ Long duration, non-smokers, location on tongue or floor of mouth, non-homogenous

    type, presence of epithelial dysplasia

    • Surgical excision in moderate to severe dysplasia

    ERYTHROPLAKIA

    • Red mucosal patch/plaque MC site: soft palate

    • If Both red & white changes in same lesion: Erythroleukoplakia, 17 times  risk of

    malignant transformation

    • Biopsy: suggestive of severe dysplasia

    • Treatment: Surgical excision/laser therapy

    ORAL LICHEN PLANUS

    • Chronic, autoimmune, inflammatory disease

    • MC site: Dorsum of tongue

    • Burning sensation & pain: exacerbated by trauma and hot, spicy or acidic foods

    • Wickham’s striae are whitish lines seen in papules and are typically seen in oral mucosa

    • Histology shows colloid bodies (Civatte bodies)

    • Treatment: Surgical excision, corticosteroids

    ©Aakash EduTech Private Limited | Visit us at pgplus.aakashdigital.com | Contact us: 011-40705055


    • Tacrolimus or retinoids

    ✓ MC site of carcinoma oral cavity: tongue (In India: Buccal mucosa)

    ✓ MC histological type is Squamous cell carcinoma

    CARCINOMA LIP

    • MC site: Vermillion border of lower lip

    • Presents early as a non healing ulcer on the vermillion border

    • LN metastasis occur to the submandibular or submental lymph nodes, can be B/L

    • Treatment:

    o Small < 2 cm: Managed with V or W Shaped excision, defect should < 1/3rd of total

    size, primary closure of the defect is done

    o Intermediate tumors: produce a defect between 1/3rd to 2/3rd of total lip size. These

    large defects are closed by: Johansen step technique or Abbe Estlander’s Flap

    o Large tumors or T4 - higher incidence of lymph node metastasis. Patient may

    require complete reconstruction of defect (with forearm flap suspended with

    palmaris longus tendon) with U/lor B/l neck dissection

    o Pt may require post op radiotherapy

    CARCINOMA BUCCAL MUCOSA AND CHEEK

    • SCC of the buccal mucosa should be excised with 1 cm margin including the underlying

    buccinator muscle

    • Supraomohyoid neck dissection (Levels I,II,III) is done

    ©Aakash EduTech Private Limited | Visit us at pgplus.aakashdigital.com | Contact us: 011-40705055


    CARCINOMA TONGUE

    • MC site: lateral border

    • % patients with tumor size < 2 cm have occult metastasis: most patients of carcinoma

    tongue require neck dissection, Extended supraomohyoid neck dissection is done (Level I-

    IV) along with radiotherapy.

    • Wide local excision is done with a 2 cm margin

    • T3 and above tumors can involve the floor of mouth and mandible: a major resection of

    tongue (reconstruction is done with radial forearm flap), floor of mouth and mandible is

    required

    • T4 tumors often cross midline thus total glossectomy is needed in many cases

    SALIVARY GLAND TUMORS

    BENIGN TUMORS:

    • Pleomorphic adenoma (MC neoplasm of salivary gland)

    • Warthin’s tumor

    • Oncocytoma

    • Myoepithelioma

    • Hemangioma (MC neoplasm of salivary gland in children)

    MALIGNANT TUMORS:

    • Mucoepidermoid carcinoma (Most common)

    • Adenoid Cystic carcinoma (MC malignant tumor of minor salivary glands)

    • Acinic cell carcinoma

    • Basal cell carcinoma

    • Squamous cell carcinoma (MC in submandibular gland)

    • Clear cell carcinoma

    ©Aakash EduTech Private Limited | Visit us at pgplus.aakashdigital.com | Contact us: 011-40705055


    PLEOMORPHIC ADENOMA

    • It is the MC tumor of the parotid gland

    • MC benign tumor of the parotid gland

    • MC benign tumor of submandibular gland

    • MC in females than males

    • It is a mixed tumor composed of epithelial and mesenchymal elements

    • C/F: painless mass, the ear lobule is lifted up

    • Curtain sign : Swelling is mobile but the zygomatic process doesn’t allow the swelling to

    move above it

    • If the deep lobe is involved it pushes the tonsil medially

    • In few cases it can undergo malignant transformation known as Carcinoma ex

    pleomorphic adenoma characterised by rapid growth, pain, facial nerve involvement and

    enlargement of cervical glands

    • Treatment: Superficial parotidectomy is treatment of choice

    • If deep lobe involved or tumor is arising from deep lobe: Total parotidectomy with

    preservation of facial nerve is done

    • Post op radiotherapy is also required in many cases

    ❑ ❑ ❑

    ©Aakash EduTech Private Limited | Visit us at pgplus.aakashdigital.com | Contact us: 011-40705055

    You might also like