مثل هذه الملاحظات عبارة عن معلومات كانت إجابات لأسئلة الدكاترة اللي وردت في تجارب الطلاب في الدفع السابقة و كذلك بعض تجارب دفعتنا...

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Clinical Surgery Pearls.

It's a nice clinical book in selected issues in surgery, in form of questions and answers with focus on practical side.

It's really an amazing book, especially the layout of information .

Submandibular gland

◼️It is smaller than the parotid gland, but larger than the sublingual gland.

◼️On each side, the submandibular gland consists of two parts, the superficial part is outside the bounderies of the oral cavity and it lies beneath the mylohyoid muscle (see fig), it has a greater volume than the deep part of the gland.

◼️The deep part loops around the posterior margin of mylohyoid muscle to enter the floor of the oral cavity, it is lateral to the base of the tongue lying on the outer surface of hyoglossus muscle.

◼️The deep part makes an impression on the inner aspect of the mandible, which is known as the submandibular fossa.

◼️The submandibular duct (Wharton's duct) emerge from the medial aspect of the deep part, and passes forwards in the floor to open beside the base of the lingual frenulum.

◼️The lingual nerve (a sensory nerve from the mandibular nerve) passes beneath the submandibular duct crossing it from a lateral to a medial direction (see above fig).

#Salivary
#Surgery

Sublingual gland

◼️It is the smallest of the three major paired salivary glands.

◼️The gland lies in the floor of the oral cavity immediately lateral to the submandibular duct (Wharton's duct) and associated lingual nerve (see previous post).

◼️The sublingual gland lies directly against the medial surface of the mandible making a shallow groove called sublingual fossa, it is above the anterior 1/3 of mylohyoid muscle. (see above fig).

◼️The superior surface of the gland raises a fold of mucosa at the floor of oral cavity known as the sublingual fold, which is easily visible, the gland is drained by numerous minor sublingual ducts that opens onto the crest of the sublingual fold.

◼️Occasionally the anterior portion of the gland is drained by a major sublingual duct that opens together with Wharton's duct besides the base of the lingual frenulum.

#Salivary
#Surgery

Cases that are found in surgery ward :

Male ,Room1:

Epigasric hernia
Femoral fracture
Hernia "inguinal "
Neck swelling
Renal stone
Bilateral hernia .

Femoral fracture is post-operative "Young male".

The others are pre-operative .

Male ,Room 2:
Inguinal hernia
Inguinal hernia
Inguinal hernia .

Two cases have a previous history of operation for contralateral inguinal hernia .

Female ,Room 1:
Epigasric or umbilical hernia
GB
Fracture leg
Fracture
Umbilical or Epigasric hernia
Lung hydatid cyst "young pt".

The main presentation of the patient of pulmonary hydatid cyst is chest pain as her mother said.
She is seven years old.

Female ,Room 2:
GB
GB
Post-operative" ileocaecal mass" young male
GB
Renal stone
Hydatid cyst "Liver", post -operative .

Female ,Room 3:
Goiter
Penile meatal stenosis
Submadibular gland stone
Hydatid cyst "Liver "
Umbilical or Epigasric hernia

Differential diagnosis of right iliac fossa mass

◼️We can remember them as 4 iliocecal, 4 appendiceal, and 4 surrounding masses, these include the commonest causes and not all of them.

1) Four iliocaecal :
- Crohn's disease.
- Iliocaecal tuberculosis.
- Iliocaecal actinomycosis.
- Tumours of caecum and distal ileum.

2) Four appendiceal :
- Appendicular inflammatory mass.
- Appendicular abscess.
- Mucocele of vermiform appendix "see above figure".
- Appendicular tumours "most common is carcinoid tumour".

3) Four surrounding masses :
- Psoas abscess.
- Desmoid tumour.
- Hernia.
- Aneurysm of iliac artery.

#Surgery

Inguinal hernia VS Femoral hernia.

#Surgery

Epigasric hernia .

#Surgery

Differences between Umbilical and Paraumbilical hernia .

Note the DDx ,very important .

#Surgery

It's like history of the swelling.

WHO Informal Working Groups on Echinococcosis Classification of Hepatic Echinococcal Cysts" Hydatid cyst ".

#Surgery.