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Career Tips
Published in John Larkin, 101 Top Tips in Medicine, 2021
Tips are not intrinsically bad things (though never trust them if they’re described as ‘Top’) and the above examples aren’t too distressing. But you can’t let them take the place of normal thinking. All three candidates also asked – with regard to ‘pincer function’ – for the patient to do up a button. Her clothes didn’t include a button (she had rheumatoid arthritis!) to which their reaction can only be described as… annoyance. One entirely gave up the idea of assessing pincer grip. His tip-withdrawal paralysis was even more clamant when it came to the scleroderma patient.120 He volunteered checking for microstomia and asked the patient to put three fingers in her own mouth. As her fingers had severe flexion contractures (she had scleroderma! What planet do these tips come from?), this was a non-starter. He again gave up: So… does she have microstomia?I don’t know.Why not?Her fingers are flexed… the test doesn’t work… you should be able to get three fingers …But… she’s still got a mouth??!Well… is it small?… don’t know… can’t tell… her fingers are flexed and…Tips are just tips. You should always know the idea behind them. And you should always think of them as ‘extras’ – ways for things to be done that bit better. If they don’t work, you have to go back to first principles. So it does help if you know some.
Common rhinology and facial plastics viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Defects less than one-third of the lip width can be closed primarily in a V or W fashion. Larger defects require local tissue transfer. This may maintain orbicularis integrity, preserving function at the expense of microstomia or may transfer additional tissue into the lip region, potentially compromising function. Two examples are as follows: Abbé flap: This full-thickness flap is used to reconstruct upper or lower lip defects between one-third and two-thirds of the lip width. A wedge of the unaffected lip is rotated into the defect on its vascular attachment medially. The pedicle, which initially bridges across the mouth, is divided at 2–3 weeks. When the defect involves the oral commissure, the technique is known as the Abbé-Estlander flap. This produces rounding of the oral commissure which is revised at 2–3 weeks.Karapandzic flap: This flap is used for the reconstruction of larger midline lower or upper lip defects. It is an axial rotational flap based on superior and inferior labial arteries. It has the advantage of maintaining commissure integrity and thus oral competence, sensation, and movement, but the disadvantage of creating microstomia and relatively unsightly scarring.
Evaluating Toxic Tort Cases
Published in Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson, Legal Nurse Consulting Principles and Practices, 2019
William P. Gavin, Mark A. Love, Wendie A. Howland
Diffuse scleroderma may make it difficult to bend fingers, hands, and other joints. There can be inflammation of the joints, tendons, and muscles. Facial skin involvement can cause microstomia. The skin can lose or gain pigment, making areas of light or dark skin. Some people lose hair on the limbs, sweat less, and develop dry skin because of damage to hair follicles and sweat glands (Johns Hopkins Sclerodoma Center, 2018). Diffuse systemic sclerosis typically occurs relatively suddenly. Thickening of the skin begins in the hands and spreads symmetrically over the body.
22q11.2 microduplication syndrome and juvenile glaucoma
Published in Ophthalmic Genetics, 2018
Federico Di Matteo, Paolo Bettin, Giulia Ferrari, Marina Fiori, Carlo Ciampi, Emanuela Manfredini, Alessandro Rabiolo, Francesco Bandello
A 26-year old male (Figure 1) was referred for a surgical evaluation of juvenile glaucoma. In 2013, he underwent uneventful phacoemulsification in his right eye. The patient had a prior diagnosis of oral (tongue) cancer, multiple brain aneurysms, epilepsy, and hypogonadism. He had micrognathia, microstomia, high arched palate with no cleft, dental anomalies, and alopecia. His medical therapy included levetiracetam for seizure control and testosterone replacement treatment. The patient was the product of an uncomplicated full-term pregnancy and delivery. Family history was negative for glaucoma or other significant ocular diseases.
Living with systemic sclerosis: the point of view of patients
Published in Current Medical Research and Opinion, 2021
Interstitial lung disease and pulmonary arterial hypertension may force patients to depend on oxygen therapy, hampering their independency and mobility7. Painful digital ulcers, flexion contractures of the fingers, decreased motion of the joints and reduced mouth opening (microstomia) may limit daily activities, making even the simplest everyday actions difficult (getting dressed, grabbing glasses, having a shower, eating, speaking, etc)8–10. Lastly, visible facial changes, body image issues and gastrointestinal involvement may have an impact on the patients’ social lives11,12.
Emerging drugs for the treatment of epidermolysis bullosa
Published in Expert Opinion on Emerging Drugs, 2020
Matthias Titeux, Mathilde Bonnet des Claustres, Araksya Izmiryan, Helene Ragot, Alain Hovnanian
Enamel defects in JEB result in excessive dental caries and premature tooth loss and multiple caries are predominant in RDEB patients. Regular cleansing of teeth with soft brushes, reconstruction of damaged tooth surfaces and ‘mouth expanding’ devices are recommended to limit microstomia.