Category: Surgery

Chemical Burns

Chemical burns are a unique subset of burns that require specialised management due to the nature of the substances involved. Proper initial management is critical to prevent further tissue damage and systemic complications.  The majority of acid burns cause coagulative necrosis and cytotoxicity leading to skin and mucosal changes that limit deeper injury. Alkali burns

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Animal Bites

Introduction Patients regularly present to the emergency department with animal bites. This article aims to help guide you through managing these patients and what factors you might want to consider. Epidemiology The number of animal bites presented to A&E is largely underestimated, as many who are bit don’t present to receive medical care1 or won’t

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Infective Flexor Tensosynovitis (Flexor Sheath Infection)

Introduction Epidemiology Flexor sheath infections prevalence ranges from 2.5% to 9.4% of hand infections2. Pathophysiology Clinical Features Differential Diagnosis Infectious: felon, herpetic whitlow cellulitis, septic arthritis, collar button abscess, deep space infections5. Noninfectious: gout, autoimmune e.g. rheumatoid arthritis, overuse tenosynovitis5. Investigation Management Immediate management: Operative management: Non-operative management: Complications Complication rates can reach as high

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Dry Eye Disease

Introduction Dry eye disease, also known as keratoconjunctivitis sicca, is a common eye disorder characterised by insufficient lubrication and moisture on the surface of the eye. This results in uncomfortable symptoms such as gritty feeling, stinging, eye watering and eye fatigue. It can cause visual disturbances and in severe cases can potentially damage the ocular

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Ptosis

Introduction Facial photo showing a patient with involutional ptosis of the right upper eyelid. Image from American Academy of Ophthalmology: https://www.aao.org/education/image/ptosis-5 Anatomy Sagittal section showing the superior tarsal muscle (Müller’s muscle) and levator palpebrae superioris muscle. They both elevate the eyelid by pulling on the tarsus plate. Image from:  Cury, M.C., Sebastiá, R. (2021). Anatomy

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Temporomandibular Joint Pathology 

The temporomandibular joint (TMJ) connects the mandible to the skull. The image below shows the anatomy. The joints are essential for jaw movements.  TMJ Disorders   TMJ disorders are common and cover musculoskeletal conditions impacting the muscles of mastication and the TMJ. Causes are multifactorial and related to anatomy, trauma, grinding or clenching of the teeth

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Salivary Gland Pathology

Problems with salivary glands are often seen at GPs and in emergency departments. It is important to be able to differentiate between different causes of facial pain and swelling. Anatomy  There are 6 main salivary glands (3 pairs); parotid, submandibular and sublingual. There are hundreds of other minor salivary glands throughout the mouth. The parotid

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Lumps, Ulcers and Patches in the Mouth 

Patients often present to GP practices with oral lesions as they may struggle to get a dental appointment. It is important to know which lesions need to be referred and which lesions are potentially serious and need an urgent 2WW referral.  Ulcers  Ulcers indicate a break in the oral mucosa. Oral ulcers are very common

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Facial Trauma

Facial trauma commonly presents in Emergency Departments and primary care. More advanced facial trauma will be redirected to major trauma centres. Due to the proximity to vital structures, it is essential to be able to assess these injuries appropriately and escalate accordingly. History If the patient is stable, it is important to start with a

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Facial Pain

Facial pain is common, and it can be not easy to form a certain diagnosis. In this article, we will provide a differential for the causes of facial pain and key features to consider. These rely on a thorough pain history, followed by examination and investigations as necessary. If the cause of pain is unclear

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