DOCSLIB.ORG

“Kratschmer” Reflex During Rhinoplasty

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
“Kratschmer” Reflex During Rhinoplasty Letters to the Editor the introducer can be used multiple times, it is also cost-effective. Lakshmi Jayaraman, DA, DNB Nitin Sethi, DNB Arvind Kumar, DOT Jayashree Sood, MD, FFARCS, PGDHHM Department of Anesthesiology Pain and Perioperative Medicine Sir Ganga Ram Hospital New Delhi, India [email protected] REFERENCE 1. Phelan MP. Use of the endotracheal bou- Figure 4. gie introducer for difficult intubation. Nick in the gum elastic bougie. Am J Emerg Med 2004;22:479–82. DOI: 10.1213/01.ane.0000242645.97899.74 “Kratschmer” Reflex During Rhinoplasty To the Editor: We report an unusual complica- tion following nasal packing after rhinoplasty to illustrate the existence and importance of the primitive “Kratschmer” reflex (1). Kratschmer, in 1870 first described trigeminocar- diac and trigemino-respiratory re- flexes in cats and rabbits (2,3). There are very few reports of Kratschmer reflex in the literature (4,5). Figure 5. Threading the wire into tracheal tube introducer. A 50-yr-old male ASA grade-I un- derwent rhinoplasty under general anesthesia. At the end of the proce- dure, as his nose was being packed with gauze, he developed sudden bradycardia and bronchospasm for which we gave atropine sulfate 0.6 mg IV. After symptomatic relief, we reversed the neuromuscular block- ade and extubated the trachea. In a few minutes he developed severe re- spiratory distress due to persistent bronchospasm and pulmonary edema. We reintubated the patient’s trachea. In the absence of knowing about other predisposing factors for bron- chospasm, we surmised that nasal Figure 6. Gum elastic bougie with the metallic wire inside. packing lead to the Kratschmer re- flex. We removed the nasal pack, and the patient was relieved of broncho- intubation stylet (medium). We then (Fig. 6). The result is that the angu- spasm. Because of negative pressure nicked the distal end of the bougie lated tracheal end of the bougie re- pulmonary edema, he required me- and gently threaded the metallic wire mains soft and nontraumatic, but the chanical ventilation for 24 h, after into the introducer, until the wire rest of the bougie is stiff and adjust- which he was weaned off the venti- reached 2 cm from the angled tip able for tracheal intubation. Because lator and tracheally extubated. There Vol. 103, No. 5, November 2006 © 2006 International Anesthesia Research Society 1337 Letters to the Editor were no further episodes of brady- 5. Blanc VF. Trigeminocardiac reflexes (Edi- used the dental cast model to char- torial). Can J Anaesth 1991;38:696–9. cardia or bronchospasm. 6. Widdicombe J, Lee LY. Airway reflexes, acterize the patient’s retromolar tri- Stimulation of receptors in the tri- autonomic function and cardiovascular gone, and verified adequate room for geminal nerve distribution area re- responses. Environ Health Perspect 2001; placement of a 7.5-mm endotracheal 109 (Suppl 4):579–84. sults in reflex changes in autonomic, 7. Schall B, Probst R, Strebel S. Trigemino- tube. cardiovascular, and respiratory sys- cardiac reflex during surgery in cerebel- We induced anesthesia with IV tems (6). Most of the reports of lopontine angle. Neurosurg Focus 1998;5: fentanyl and propofol, and para- Article 5. Kratschmer reflex described cardio- DOI: 10.1213/01.ane.0000242646.27533.35 lyzed the patient with vecuronium. vascular changes with potent stimuli, We performed oral endotracheal in- such as elevation of bone flap or Dental Cast Model as an tubation and fixed the tube with osteotomies. Lang et al. (4) reported Airway Management wire ligature. After noticing the pa- three cases of possible Kratschmer Planning Tool tient’s passive clenching of teeth, reflex in patients undergoing correc- we checked the adequacy of venti- tive facial osteotomies. The cardiovas- To the Editor: lation and the airway pressures. cular changes during cerebellopontine A 23-yr-old female was sched- Surgery proceeded uneventfully for angle tumor resection suggest the pres- uled for Le Fort I osteotomy ad- 5 h and we extubated the trachea ence of a central induction and efferent vancement, calvaria bone grafting, after ensuring we could maintain a pathway of trigeminocardiac reflex in and rhinoplasty to repair a Class patent airway. Preoperative use of a humans (7). Our case illustrates that II malocclusion and persistent na- dental cast permitted us to proceed moderate stimuli like nasal packing sal deformity. She had undergone with a novel method of airway can evoke Kratschmer reflex. This maxillo-mandibular fixation 5 yr management. patient developed bronchospasm previously for bilateral Le Fort II and laryngospasm as originally de- and nasal bone fracture. In prepara- Indu Sen, MD scribed by Kratschmer in animals tion for surgery, plastic surgeons Jyotsna Wig, MD, FAMS (2,6). In our case, atropine was effec- made a dental cast model to define Suman Arora, MD tive in treating bradycardia but bron- the patient’s precise intraocclusional Department of Anaesthesia and Intensive Care chospasm responded only partially. relationships (Fig. 1). Post Graduate Institute of Medical Education Vigilance during procedures with and Research We explored options for airway Chandigarh, India a potential to provoke a trigemino- management. Surgery did not per- Vipul Nanda, McH cardiac/trigeminorespiratory reflex mit nasal intubation. Invasive tech- is essential. Prompt interventions niques such as tracheostomy (1) or Ramesh K. Sharma, McH like cessation of surgical stimulus, submental intubation (2) carry too Department of Plastic Surgery administration of atropine, local an- Post Graduate Institute of Medical Education much risk of increased morbidity and and Research esthetic infiltration, or blockade of postoperative scarring. Therefore, Chandigarh, India the nerve may be helpful in attenu- we decided upon transoral retro- [email protected] ating or preventing the potentially molar intubation without osteotomy fatal complications of Kratschmer (3) as the ideal airway-management REFERENCES reflex. strategy. Clinical examination using 1. Lewis RJ. Tracheostomies: indications, Nirmala Jonnavithula a gloved finger and roentgenogram timing and complications. Clin Chest Department of Anesthesiology and gave us some idea about space. We Med 1992;13:137–49. Intensive Care Nizam’s Institute of Medical Sciences Punjagutta, Hyderabad, Andhra Pradesh, India [email protected] REFERENCES 1. Linton RAF. Respiratory system: struc- ture and function of the respiratory tract in relation to anaesthesia. In: Healey TEJ, Knight PR, eds. Wylie and Churchill- Davidson’s a practice of anaesthesia. Sin- gapore: PG Publishing, 1986:4. 2. Widdicombe J. Kratschmer and nasal re- flexes. Respir Physiol 2001;127:89–91. 3. Angell-James JE, Daly MB. Some aspects of upper respiratory tract reflexes. Acta Otolaryngol 1975;79:242–52. 4. Lang S, Lanigan DT, Vanderwal M. Tri- geminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. Can J Anaesth 1991;38:757–60. Figure 1. A dental cast model showing retro-molar space. 1338 Letters to the Editor ANESTHESIA & ANALGESIA.
Load more

Recommended publications
  • Septoplasty, Rhinoplasty, Septorhinoplasty, Turbinoplasty Or
    Septoplasty, Rhinoplasty, Septorhinoplasty, 4 Turbinoplasty or Turbinectomy CPAP • If you have obstructive sleep apnea and use CPAP, please speak with your surgeon about how to use it after surgery. Follow-up • Your follow-up visit with the surgeon is about 1 to 2 weeks after Septoplasty, Rhinoplasty, Septorhinoplasty, surgery. You will need to call for an appointment. Turbinoplasty or Turbinectomy • During this visit any nasal packing or stents will be removed. Who can I call if I have questions? For a healthy recovery after surgery, please follow these instructions. • If you have any questions, please contact your surgeon’s office. Septoplasty is a repair of the nasal septum. You may have • For urgent questions after hours, please call the Otolaryngologist some packing up your nose or splints which stay in for – Head & Neck (ENT) surgeon on call at 905-521-5030. 7 to 14 days. They will be removed at your follow up visit. When do I need medical help? Rhinoplasty is a repair of the nasal bones. You will have a small splint or plaster on your nose. • If you have a fever 38.5°C (101.3°F) or higher. • If you have pain not relieved by medication. Septorhinoplasty is a repair of the nasal septum and the nasal bone. You will have a small splint or plaster cast on • If you have a hot or inflamed nose, or pus draining from your nose, your nose. or an odour from your nose. • If you have an increase in bleeding from your nose or on Turbinoplasty surgery reduces the size of the turbinates in your dressing.
    [Show full text]
  • Ct Maxillofacial with Contrast Protocol
    Ct Maxillofacial With Contrast Protocol Untrue Blaine ferment retrally and encouragingly, she nogged her Narva jeweling smokelessly. Unsaluted Zak scollop: he bards his self-sacrifice lordly and trichotomously. Eliott companions perdurably. In contrast both ultra-low dose protocols that combined a larger voxel. Although some elements on maxillofacial lesions in protocol change was limited in addition, protocols were reported are extremely thin slices. Contact us see it kills thyroid functions, which are related disorders such as they safe. CT The American College of Radiology with regret than. If the protocol is changed by one then our radiologists to condition more suitable. PRACTICE PARAMETER CT American College of Radiology. Assume that ct? Separate requests for concurrent imaging of the arteries and the veins in separate head are inappropriate. You have had an hour prior to maxillofacial fibrosarcoma using special room, protocol is no additional effects research to help your details. Patient lead a candidate for curative surgery. No citing articles found no other precautions can be stored in your email address ct maxillofacial radiology facilities may affect your contrast ct with maxillofacial lesions. Pillows may est will usually, with maxillofacial ct with persistent dysesthesia as radiation. It personnel also used to narrate at blood vessels and lymph nodes in the abdomen. RESULTS Compared with the reference dose protocol with FBP the. MRI lumbar spine pain and without IV contrast is best appropriate; CT lumbar spine system or without IV contrast can be performed if MRI is contraindicated. Ordered CT exams under ARA protocols For any coding. Studies by maxillofacial with other.
    [Show full text]
  • Comparison of the Effects of Dexmedetomidine Versus Fentanyl
    Current Therapeutic Research Volume 70, Number 3, June 2009 Comparison of the Effects of Dexmedetomidine Versus Fentanyl on Airway Reflexes and Hemodynamic Responses to Tracheal Extubation During Rhinoplasty: A Double-Blind, Randomized, Controlled Study Recep Aksu, MD; Aynur Akın, MD; Cihangir Biçer, MD; Aliye Esmaoglu,˘ MD; Zeynep Tosun, MD; and Adem Boyacı, MD Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey ABSTRACT Background: Stimulation of various sites, from the nasal mucosa to the dia- phragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed while the patient is deeply anesthetized or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be dif- ficult because of the aspiration of blood and the possibility of laryngospasm. Dexmede- tomidine and fentanyl both have sedative and analgesic effects, but dexmedetomidine has been reported to induce sedation without affecting respiratory status. Objective: The aim of this study was to compare the effects of dexmedetomi- dine and fentanyl on airway reflexes and hemodynamic responses to tracheal extuba- tion in patients undergoing rhinoplasty. Methods: This double-blind, randomized, controlled study was conducted at the Erciyes University Medical Center, Kayseri, Turkey. Patients classified as Ameri- can Society of Anesthesiologists physical status I or II who were undergoing elective rhinoplasty between January 2007 and June 2007 with general anesthesia were eli- gible for study entry. Using a sealed-envelope method, the patients were randomly divided into 2 groups (20 patients per group). Five minutes before extubation, pa- tients received either dexmedetomidine 0.5 μg/kg in 100 mL of isotonic saline or fentanyl 1 μg/kg in 100 mL of isotonic saline intravenously.
    [Show full text]
  • Rhinoplasty and Septorhinoplasty These Services May Or May Not Be Covered by Your Healthpartners Plan
    Rhinoplasty and septorhinoplasty These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. Administrative Process Prior authorization is not required for: • Septoplasty • Surgical repair of vestibular stenosis • Rhinoplasty, when it is done to repair a nasal deformity caused by cleft lip/ cleft palate Prior authorization is required for: • Rhinoplasty for any indication other than cleft lip/ cleft palate • Septorhinoplasty Coverage Rhinoplasty is not covered for cosmetic reasons to improve the appearance of the member, but may be covered subject to the criteria listed below and per your plan documents. The service and all related charges for cosmetic services are member responsibility. Indications that are covered 1. Primary rhinoplasty (30400, 30410) may be considered medically necessary when all of the following are met: A. There is anatomical displacement of the nasal bone(s), septum, or other structural abnormality resulting in mechanical nasal airway obstruction, and B. Documentation shows that the obstructive symptoms have not responded to at least 3 months of conservative medical management, including but not limited to nasal steroids or immunotherapy, and C. Photos clearly document the structural abnormality as the primary cause of the nasal airway obstruction, and D. Documentation includes a physician statement regarding why a septoplasty would not resolve the airway obstruction. 2. Secondary rhinoplasty (30430, 30435, 30450) may be considered medically necessary when: A. The secondary rhinoplasty is needed to treat a complication/defect that was caused by a previous surgery (when the previous surgery was not cosmetic), and B.
    [Show full text]
  • Rhinoplasty ARTICLE by PHILIP WILKES, CST/CFA
    Rhinoplasty ARTICLE BY PHILIP WILKES, CST/CFA hinoplasty is plastic become lodged in children's noses.3 glabella, laterally with the maxilla, surgery of the nose Fortunately, the art and science of inferiorly with the upper lateral car- for reconstructive, rhinoplasty in the hands of a skilled tilages, and posteriorly with the eth- restorative, or cos- surgical team offers positive alter- moid bone? metic purposes. The natives. The nasal septum is formed by procedure of rhmo- Three general types of rhino- the ethmoid (perpendicular plate) plasty had its beginnings in India plasty will be discussed in this arti- and vomer bones (see Figure 5). The around 800 B.c.,as an ancient art cle. They include partial, complete, cartilaginous part is formed by sep- performed by Koomas Potters.' and finesse rhinoplasties. tal and vomeronasal cartilages. The Crimes were often punished by the anterior portion consists of the amputation of the offender's nose, Anatomy and Physiology of the medial crus of the greater alar carti- creating a market for prosthetic sub- Nose lages, called the columella nasi? stitutes. The skill of the Koomas The nose is the olfactory organ that The vestibule is the cave-like area enabled them to supply this need. In projects from the center of the face modem times, rhinoplasty has and warms, filters, and moistens air developed into a high-technology on the way to the respiratory tract. procedure that combines art with Someone breathing only through the latest scientific advancements.' the mouth delivers a bolus of air During rhinoplastic procedures, with each breath. The components surgeons can change the shape and of the nose allow a thin flow of air size of the nose to improve physical to reach the lungs, which is a more appearance or breathing.
    [Show full text]
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]
  • Annex 2. List of Procedure Case Rates (Revision 2.0)
    ANNEX 2. LIST OF PROCEDURE CASE RATES (REVISION 2.0) FIRST CASE RATE RVS CODE DESCRIPTION Health Care Case Rate Professional Fee Institution Fee Integumentary System Skin, Subcutaneous and Accessory Structures Incision and Drainage Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, 10060 3,640 840 2,800 cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia) 10080 Incision and drainage of pilonidal cyst 3,640 840 2,800 10120 Incision and removal of foreign body, subcutaneous tissues 3,640 840 2,800 10140 Incision and drainage of hematoma, seroma, or fluid collection 3,640 840 2,800 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst 3,640 840 2,800 10180 Incision and drainage, complex, postoperative wound infection 5,560 1,260 4,300 Excision - Debridement 11000 Debridement of extensive eczematous or infected skin 10,540 5,040 5,500 Debridement including removal of foreign material associated w/ open 11010 10,540 5,040 5,500 fracture(s) and/or dislocation(s); skin and subcutaneous tissues Debridement including removal of foreign material associated w/ open 11011 fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, 11,980 5,880 6,100 and muscle Debridement including removal of foreign material associated w/ open 11012 fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, 12,120 6,720 5,400 muscle, and bone 11040 Debridement; skin, partial thickness 3,640 840 2,800 11041 Debridement; skin, full thickness 3,640 840 2,800 11042 Debridement; skin, and
    [Show full text]
  • ANMC Specialty Clinic Services
    Cardiology Dermatology Diabetes Endocrinology Ear, Nose and Throat (ENT) Gastroenterology General Medicine General Surgery HIV/Early Intervention Services Infectious Disease Liver Clinic Neurology Neurosurgery/Comprehensive Pain Management Oncology Ophthalmology Orthopedics Orthopedics – Back and Spine Podiatry Pulmonology Rheumatology Urology Cardiology • Cardiology • Adult transthoracic echocardiography • Ambulatory electrocardiology monitor interpretation • Cardioversion, electrical, elective • Central line placement and venous angiography • ECG interpretation, including signal average ECG • Infusion and management of Gp IIb/IIIa agents and thrombolytic agents and antithrombotic agents • Insertion and management of central venous catheters, pulmonary artery catheters, and arterial lines • Insertion and management of automatic implantable cardiac defibrillators • Insertion of permanent pacemaker, including single/dual chamber and biventricular • Interpretation of results of noninvasive testing relevant to arrhythmia diagnoses and treatment • Hemodynamic monitoring with balloon flotation devices • Non-invasive hemodynamic monitoring • Perform history and physical exam • Pericardiocentesis • Placement of temporary transvenous pacemaker • Pacemaker programming/reprogramming and interrogation • Stress echocardiography (exercise and pharmacologic stress) • Tilt table testing • Transcutaneous external pacemaker placement • Transthoracic 2D echocardiography, Doppler, and color flow Dermatology • Chemical face peels • Cryosurgery • Diagnosis
    [Show full text]
  • Fitness for Air Travel – Guidelines for Doctors
    Fitness for Air Travel – Guidelines for Doctors Thank-you for submitting a MEDA form for your patient. Key physiological considerations when assessing fitness to fly: Aircraft cabins are pressurized, but not to sea level. The cabin pressure is typically equivalent of up to 8000ft. This results in: 1) Less available oxygen (partial pressure of oxygen drops to the sea-level equivalent of breathing about 15% oxygen instead of 21%) 2) Gas expansion in body cavities (approximately one-third increase in volume) – particularly relevant to middle ear, sinuses, pleural space and after some types of surgery. The following are guidelines only and a case-by-case approach, in consultation with the Air NZ Aviation Medicine Unit (AvMed Unit, ph: +64 9 256 3924), may be warranted in some circumstances. If your patient requires oxygen during flight this must be pre-arranged. Onboard emergency supply oxygen should never be relied upon for passengers who ‘may’ need oxygen. If unsure please discuss with one of our doctors. Medical Conditions and Recommendations on Fitness to Travel Cardiovascular and other Circulatory Disorders Angina If no angina at rest, can walk 50m at moderate pace without SOB or chest pain, and symptoms well controlled with medication, may travel without supplementary oxygen. Otherwise in-flight O 2 (2L/min) recommended. Unstable or severe angina i.e. cannot carry out any activity without discomfort or angina at rest, should only travel if essential, and with supplementary oxygen and wheelchair. In all cases, must bring medication in hand luggage. Myocardial infarction As per British Cardiovascular Society Guidelines, stratify according to risk.
    [Show full text]
  • Closed Rhinoplasty: Effects and Changes on Voice - a Preliminary Report
    Topic: EuRePS Meeting 2015: best five papers Closed rhinoplasty: effects and changes on voice - a preliminary report Giuseppe Guarro, Romano Maffia, Barbara Rasile, Carmine Alfano Department of Plastic and Reconstructive Surgery, University of Perugia, 06156 Perugia, Italy. Address for correspondence: Dr. Giuseppe Guarro, Department of Plastic and Reconstructive Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy. E-mail: [email protected] ABSTRACT Aim: Effects of rhinoplasty were already studied from many points of view: otherwise poor is scientific production focused on changes of voice after rhinoplasty. This preliminary study analyzed objectively and subjectively these potential effects on 19 patients who underwent exclusively closed rhinoplasty. Methods: This preliminary evaluation was conducted from September 2012 to May 2013 and 19 patients have undergone primary rhinoplasty with exclusively closed approach (7 males, 12 females). All patients were evaluated before and 6 months after surgery. Each of them answered to a questionnaire (Voice Handicap Index Score) and the voice was recorded for spectrographic analysis: this system allowed to perform the measurement of the intensity and frequency of vowels (“A” and “E”) and nasal consonants (“N” and “M”) before and after surgery. Data were analysed with the Mann-Whitney test. Results: Sixteen patients showed statistically significant differences after surgery. It was detected in 69% of cases an increased frequency of emission of the consonant sounds (P = 0.046), while in 74% of cases the same phenomenon was noticed for vowel sounds (P = 0.048). Conclusion: Many patients who undergo rhinoplasty think that the intervention only leads to anatomical changes and improvement of respiratory function.
    [Show full text]
  • 2021 Quarter 2 Advanced Book Information
    2021 Quarter 2 Advanced Book Information Featured Titles Mar-21 General Anatomy and Musculoskeletal System (THIEME Atlas of Anatomy), Latin Nomenclature, 3rd Edition Mar-21 Internal Organs (THIEME Atlas of Anatomy), Latin Nomenclature, 3rd Edition Mar-21 Head, Neck, and Neuroanatomy (THIEME Atlas of Anatomy), Latin Nomenclature, 3rd Edition Apr-21 Palpation Techniques: Surface Anatomy for Physical Therapists, 3rd Edition Jun-21 Masters of Cosmetic Surgery – The Video Atlas: The Dallas Cosmetic Model, 1st Edition Neurosurgery Titles Jun-21 Neurointervential Surgery: An Evidence-Based Approach, 1st Edition Radiology Titles Apr-21 Imaging Anatomy: Text and Atlas Volume 1, Lungs, Mediastinum, and Heart, 1st Edition May-21 Radiology Structured Reporting Handbook: Disease-Specific Templates and Interpretation Pearls, 1st Edition May-21 CT Teaching Manual: A Systematic Approach to CT Reading, 5th Edition Orthopaedic Titles Jun-21 Synopsis of Hand Surgery, 1st Edition Student Titles May-21 Thieme Review for the USMLE®: A WIN for Step 2 and 3 CK, 1st Edition Communication Science Titles May-21 Speech Sound Disorders: Comprehensive Evaluation and Treatment, 1st Edition Other Titles Apr-21 Chinese Nutrition Therapy: Dietetics in Traditional Chinese Medicine (TCM), 3rd Edition May-21 Science of Synthesis: Knowledge Updates 2021/2, 1st Edition Jun-21 Spectroscopic Methods in Organic Chemistry, 3rd Edition Additional Information Out of Print Jan-March 2021 Representatives & Exclusive Distributors TITLE General Anatomy and Musculoskeletal System (THIEME
    [Show full text]
  • Rhinoplasty Surgery
    INFORMED CONSENT – RHINOPLASTY SURGERY ©2009 American Society of Plastic Surgeons®. Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's own practice only. All other rights are reserved by American Society of Plastic Surgeons®. Purchasers may not sell or allow any other party to use any version of the Patient Consultation Resource Book, any of the documents contained herein or any modified version of such documents. INFORMED CONSENT – RHINOPLASTY SURGERY INSTRUCTIONS This is an informed consent document that has been prepared to help inform you concerning rhinoplasty surgery, its risks, and alternative treatment. It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon and agreed upon by you. GENERAL INFORMATION Surgery of the nose (rhinoplasty) is an operation frequently performed by plastic surgeons. This surgical procedure can produce changes in the appearance, structure, and function of the nose. Rhinoplasty can reduce or increase the size of the nose, change the shape of the tip, narrow the width of the nostrils, or change the angle between the nose and the upper lip. This operation can help correct birth defects, nasal injuries, and help relieve some breathing problems. There is not a universal type of rhinoplasty surgery that will meet the needs of every patient. Rhinoplasty surgery is customized for each patient, depending on his or her needs. Incisions may be made within the nose or concealed in inconspicuous locations of the nose in the open rhinoplasty procedure.
    [Show full text]