Susac syndrome

Introduction: Susac syndrome was first described by Susac etal in 1979. This syndrome is characterised by rapidly progressing encephalopathy, blindness and hearing loss. Pathophysiology: This is actually an endotheliopathy affecting precapillary arterioles. This endotheliopathy could probably be immune mediated. This causes rapid tissue infarction which leads to these problems. Women are commonly affected than men. Typical vulnerable age group is between 20 – 40. Clinical features: 1. Severe head ache 2. Rapid dementia 3. Micro infarcts seen in corpus callosum demonstrable in MRI scans 4. Photopsia and black spots due to retinal artery occlusion 5. Scintillating scotoma 6. Rapidly progressive sensori neural hearing loss on both sides 7. Vertigo 8. Nystagmus Management: High dose steroid therapy is the main treatment modality. Intravenous administration of immunoglobulin. Cyclophosphamide administration. Rituximab is the currently used drug in the management. This is a monclonal antibody against CD20 protein. This receptor protein is found on the surface of B lymphocytes.

Nasal polypi a presentation

Mandibular swing approach a step by step approach

Mandibular Swing

Mandibular swing approach for Parapharyngeal mass lesions Video clipping

Mandibular swing approach for parapharyngeal mass lesions An E Atlas

Orbital disorders

Orbital Disorders

Coablation tonsillectomy

Introduction:
Tonsillectomy is a commonly performed surgical procedure these days. With the advent of latest surgical equipments and innovations the risks involved in the surgical procedure has been considerably reduced. One such emerging technological innovation is the introduction of coablation technology which is currently being used to perform tonsillectomy.

Emerging technology – Current expectations:

Technological innovations in any surgical procedure should focus on the following parameters:

Bloodless surgical field
Reduction in the surgical time
Reduced post operative pain
Improved healing rates
Affordability
Safety

Coablation:
This is also known as “Controlled ablation” / “Cold ablation”. This technology uses bipolar high frequency electrical energy to exite the electrolytes in a conductive medium. This excitation creates a plasma field which is higly focussed. The ions present in the plasma field are highly energized and this energy is sufficient to break organic molecular bonds found in the living tissue. This energy dissolves soft tissue at relatively low temperatures, while preserving the integrity of surrounding tissue. Sodium chloride solution is commonly used as a conducting medium in coablation surgical procedures.

Advantages of coablation:

It operates at relatively cool temperatures (40 – 70 degrees centigrade)
Its cutting effect is very precise with very minimal effect on the surrounding tissue
The plasma field which is generated by this equipment is about 100 – 150 microns thick. This is the reason for its precision

Plasma field:
This is the technology involved in coablation surgical procedures. Plasma field is defined as a collection of charged particles (equal amounts of positive and negative ions). Plasma field resembles gas physically in some respects, but show significant differences as well. Plasma field is a good conductor of electricity and is affected by the presence of magnetic field, where as it is not so with gases.

Crudely put plasma is a state of matter in which many electrons are free and unbound and move independently. Coablation technology utilizes this phenomenon by generating an electrical field between two small electrodes. This electrical field when made to pass through a medium like normal saline which conducts it rather well, the sodium and chloride molecules become energized and separate from the solution. These sodium and chloride ions are responsible for the formation of plama field.

The wand used in coablation surgical procedures has channels for suction and irrigation. Normal saline should flow through irrigation channel and central suction should be connected to the suction channel.