HEAD & NECK 2

2.1 CLEFT PALATE.

The two maxillary shelf's may fail to unite in the midline

leaving a gap in the palate, or it may extend to the premaxillar in the

front leaving a complete gap leading into the nosal cavity

This defect causes feeding problems because of regurgitating of food.

This defect occurs in 1-3 births/1000

TREATMENT

Repair of these defects surgically is attempted between 9months to 1 year

years.

This repair and are its steps shown in Fig.above 

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HEAD & NECK 1

HEAD AND NECK

1. INTRODUCTION

The  face  and neck are prominent visible parts of the  body  and

used for human communication through facial expression, movements of  the  head  and speech. 

They deserve  special  attention  from treating surgeons in all disorders of this region so as to ensure patient's acceptance of the results of treatment and thus  insure

his satisfaction.

 

2. CONGENITAL DEFECTS

CLEFT LIP (HARE LIP)

- The incidence is one in 800 to 1300 live births.

- This defect can be unilateral or bilateral and can be  complete

  with  the defect running into the nose. the minor form of a  small

  notch in the lip or partial. 

- There is also hypoplasia of the muscle of the upper lip.  

- The cleft lip is associated with a cleft of the palate on that side.

 

TREATMENT

 

The  clefts  of the lip are closed within the first 3  months  of

life. The margins of the cleft are incised at the margin of  skin

and  mucosa.   The  flaps mobilised and mucosa  muscle  and  skin

margins sutured accurately

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Malignant Breast Carcinoma 7

8. Male Breast Cancer

It is an infrequent cancer for a 100 cancers in the female breast

one occurs in the male. 

These are infilterating duct carcinomas. 

There is early involvement of Pectoralis Major

TREATMENT

In most cases is a radical mastectomy

PRIMARY CARE PRECEPTS

1. Prevent  breast infection by nipple hygiene  simple  cleansing

   using clean water during lactation.

2. If  excess  pain or tension is felt use manual  extraction  of

   milk or breast pump.

3. If  pain in one breast and fever with local heat  and  redness

   refer for surgery.

4. If  there  is  a firm painless lump in the  breast  refer  for

   investigation and surgery to district hospital.

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MALIGNANT Breast Cancer 6

7. TREATMENT

The treatment modes available for Cancer Breast are:

   1.  Surgery

   2.  Radiotherapy

   3.  Chemotherapy

   4.  Hormonal therapy

*  Surgery is reserved for early cancer breast in cases of  stage

   I(T1 No) and stage II(T1, T2, N1).

   The operations in use today are:

   1.  Radical Mastectomy (Halstead)

       This  procedure is aimed at removing the whole  breast  the

       underlying  Pectoralis  major and minor  and  the  regional

       lymph  nodes  along  the  axillary  vein.   No   prosthatic

       reconcentration  is possible after the chest  wall  muscles

       have been removed.

   2.  Modified Radical Mastectomy (Patey's)

       In  this procedure all the structure accept the  Pectoralis

       Major are removed

   3.  Modified Radical Mastectomy (Maddon's)

       In  this procedure the pectoralis minor is divided but  not

       removed

   4.  Simple Mastectomy and clearance of lymphnodes from the

       axilla

       The  skin incision is eliptical and starts at over  rectus

       sheath and includes the nipple and the upper end is  above

       the  margin of the pectoralis major.  Both upper flap  are

       mobilised till the upper and lower limits of breast tissue

       are expanded.  The breast tissue (and nipple) are directed

       off  the pectoralis major.  The later end of the  incision

       allows excessing axillary lymph nodes.

   5.  Wide  local  excision of the tumour  with  preservation  of

       breast followed by radiation.

The  surgical procedure is dependent on the  surgeons  preference

and  the  clinical  stage of the disease. There is  a  trends  to

choose a less radical procedure among surgeons today.

*   Chemotherapy and hormone therapy (adjuvant therapy)is added to

    surgery in cases of Stage II.

It  has  been shown that chemotherapy has benefitted  both  those

with  nodes and those without nodes. 

Tomoxifen has also been  of benefit  to receptor positive and receptor poor tumours when  the

patient is over 50 years.

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