Femoral triangle.

#Surgery

Femoral sheath.

#Surgery

Femoral canal.
F. ring and S. opening.

#Surgery

Adductor canal, popliteal fossa.

#Surgery

أهم علامة تدل أن الـ Foly's catheter بمكانها الصحيح؟

-Gush of urine.

•Difference between submandibular lymph node and submandibular gland swelling:

1. Nodes usually are multiple while gland single swelling
2. Node could be over rided the body of mandible while the gland is not
3. Gland could be palpated bimanually
(From the skin and from the floor of tongue )
4.gland swelling and pain may increase during induce sour food while node show no changes
5. As the most common cause of submandibular gland swelling is duct stone we may feel it by palpation.

#Surgery

High yield notes about salivary gland disorders

◼️80% of parotid tumors are benign, the commonest one is pleomorphic adenoma, 80% of parotid tumors arise in their superficial part.

◼️Pleomorphic adenoma has an incomplete capsule, enucleation of the tumor results in recurrence in most cases as seeds of cells are likely left behind.

◼️Medial displacement of the tonsil can be caused by enlargement of the deep part of parotid gland, a part of the parotid gland loops around the mandibular ramus.

◼️Salivary gland stones are commonest in the submandibular gland.

◼️Parotid gland stones are less common because its secretions are watery and its duct drains more easily compared to the viscid secretions of the submandibular gland and its up sloping duct making drainage more difficult.

◼️Plunging ranulas occur only in the sublingual gland because its the only salivary gland which secretes continuously.

◼️Although generally rare, the majority of tumors arising in the sublingual gland are malignant (90%).

◼️The vast majority of minor salivary gland tumors are malignant.

◼️Drainage of an abscess in the parotid gland should be done by Hilton's method to safeguard the facial nerve.

#Salivary
#Surgery

Submandibular sialadenitis

◼️Sialadenitis is a term given to inflammation of the salivary gland.

◼️It may be viral or bacterial, viral infection is usually caused by mumps virus, bacterial infection is more common and is caused by an obstruction in the submandibular duct system

◼️Obstruction is usually caused by stones, salivary gland stones are most common in the submandibular gland as secretions are viscid and are more difficult to drain compared to the watery secretions of the parotids

◼️80% of submandibular gland stones are radio-opaque,and can be seen by inferior occlusal view,the above figure shows two stones, large arrow shows a small stone near the sublingual papilla small arrow shows a larger stone near the gland's hilum

◼️Clinical presentation depends on degree of obstruction,complete obstruction usually caused by stones at the ductal opening present with pain and swelling precipitated by meals partial obstruction present with infrequent symptoms with less pain and swelling.

#Salivary
#Surgery

In submandibular gland stones:

Plain x-ray (closed mouth view):
-Stone in the submandibular gland is radio-opaque in 8o ٪ of cases.

Sialogram:
-Shows the radiolucent stones.


بعكس الـ Parotid stones اللي هن أصلاً rare، وكذا يكونين Radiolucent.

#Surgery

How to differentiatebetween submandibular gland stones and submandibular LN Enlargement?

-History of pain and swelling that increase after eating
-Swelling is solitary and can't be rolled over the mandible. مايقدرش يتحرك فوق.
-Inspection of the mouth floor may reveal redness of duct orifice.
-Bimanual palpation reveals swelling is filling the floor of the mouth.

#Surgery

What is Curtain sign?

Curtain sign is—deep fascia/ parotid sheath is attached above to the zygomatic bone and so swelling arising from parotid gland cannot be moved up beyond zygomatic bone wherein deep fascia acts like a curtain to prevent its further mobility.

-It's seen in pleomorphic adenoma.

#Surgery

-Swelling superficial to deep fascia of parotid can be moved beyond the level of the zygomatic bone above.

#Surgery

Technique for examination of thyroglossal cyst and name of operation:


-Elicit fluctuation by Paget’s method or test.
-It may appear as firm or tense cystic.
-Some cysts are too small to fluctuate.

-Sistrunk’soperation is the surgery of choice:
consists of removal of the  thyroglossal cyst along with  the  entire thyroglossal tract up to the foramen cecum. The central part of the body of the hyoid bone (1cm) is excised during the process of excision of the tract , to prevent recurrence.

#Surgery

INDICATIONS OF CBD EXPLORATION:

1. History of charcot’s triad
2. USG proven stones in CBD
3. Dilated CBD (>1cm)
4. OTCshows filling deffect
5. Palpable stones in CB.

#Surgery

-The only effective treatment of Retrosternal goiter is surgery.

-The antithyroid drugs in pre-operative preparation or treatment are contraindicated, Why?

-Because they will lead to ↓in thyroid hormones levels which lead to feedback activation of TSH that causes increased thyroid growth and size with more obstruction at neck without effect on hormone levels!!

So they use BB as Propranolol.
#Surgery

Remember:

-Best diagnostic modality for parotid swelling: FNAC.

-Open incisional biopsy is contraindicated; due to tumor cell implantation and formation of parotid fistula.

-Best imaging investigation for salivary gland neoplasms: MRI.

#Salivary_glands

Remember:

Umbilical Hernia:

-It may be seen normally in some children and may close spontaneously by 2 years.

-The following conditions are usually associated with umbilical hernia:

• Down's syndrome
• Cretinism
• Hurler's syndrome
• Hunter's syndrome.

#Pediatrics