Question

Purple Team :  

Discuss preoperative and postoperative care of the rhinoplasty patient and possible postoperative complications of a patient undergoing a rhinoplasty.

 

Gold Team : 

Discuss the signs and symptoms that a patient will exhibit with tuberculosis and  the type of precautions that must be followed when caring for a patient with tuberculosis

Answer 1

Purple Team

Postoperative swelling depends mainly on the osteotomy technique. Percutaneous osteotomies cause less trauma, but may result in visible scars.Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases. The analysis of postoperative deformities allowes the identification of specific risks. The most frequent postoperative deformity is the “pollybeak” when a deep naso-frontal angle, cartilaginous hump and reduced tip projection are present preoperatively. The pollybeak is the indication in about 50% of all revision rhinoplasties. Other frequent postoperative deformities are a pendant and wide nasal tip, retractions of the columella base or irregularities of the nasal dorsum. These deformities are very often combined and caused by a loss of septal support. This is why the stability of the caudal septum in septorhinoplasty is the key for a predictable result. Maintaining the position of the tip and the columella is one of the main issues to avoid typical postoperative deformities.

General remarks complications

In spite of severe risks and complications , residual or newly developed deformities are considered to be the main risk of rhinoplasty. Statistic data are problematic, even in retrospective studies on more than 1000 patients. These studies are based on revisions performed by a single surgeon or institution. Because of this specialisation revision surgery is frequent as patients are referred to these centers. It would be more interesting to analyse revisions after primary rhinoplasty by a single surgeon. However even these data may show bias because

• not all postoperative deformities are revised and
• not all patients who are dissatisfied return to the primary surgeon.

In addition specialists in rhinoplasty may have less complications because of their experience. This is why reports on frequencies of postoperative deformities may only give a rough idea about the risks while an analysis of the types of deformities found at revision surgery can give information on critical areas and techniques. Many patients feel insecure in the immediate post-operative period. A positive comment from a bystander (nurse, e.g.) upon removal of the splint can make a big difference in the way the patient will react to the first glance in the mirror. A careful massage of the nasal soft tissues beginning two weeks after surgery and local injections of corticosteroids (Triamcinolone) can speed up the resorption of oedema.

Gold team

Symptoms of TB

People with TB of the lungs have a chronic cough, generally lasting for more than two weeks. They can also cough up blood. People with TB in any part of the body have fevers, night sweats, and weight loss. People with these symptoms should tell a health care provider so they can be evaluated for TB.People living with HIV/AIDS are at extra risk of getting sick from TB because their body cannot fight off germs very well. If someone develops symptoms of coughing for more than two weeks, coughing up blood, weight loss, fevers or night sweats, it is important to get checked for TB. TB can be cured even in persons with HIV/AIDS.

Cough lasting more than three weeks is often a first symptom of active tuberculosis (TB). It can start as a dry irritating cough. It tends to continue for months and get worse. In time the cough produces a lot of phlegm (sputum), which may be bloodstained.

Other common symptoms are a high temperature (fever), sweats, feeling unwell, weight loss, pains in the chest, and poor appetite. You may become breathless if the infection progresses and damages the lungs. If left untreated, complications often develop, such as fluid collecting between the lung and the chest wall (pleural effusion). This can make you very breathless. If the TB gets close to a blood vessel in the lung then you may cough up blood.

TB infection sometimes spreads from the lungs to cause infection in other parts of the body. Depending on which part of the body is affected, various symptoms may then occur:

• Lymph glands - you may have a swollen gland or glands anywhere in the body. If the swollen glands are in the neck, armpit or groin then you may see or feel them.
• Gut and tummy (abdomen) - the TB may cause tummy pain or swelling, or poor digestion of food with diarrhoea and weight loss.
• Bones and joints - TB can get into a bone or joint, causing bone pain (for example, in the spine) or pain and swelling in a joint.
• Heart - TB sometimes causes inflammation around the heart, with chest pain or shortness of breath.
• Kidneys and bladder - if these are infected, you may have pain in the side (loin), or pain when passing urine.
• Brain - TB can cause meningitis, with symptoms such as:
  • Headache.
  • Feeling sick (nausea).
  • Being sick (vomiting).
  • Fits (convulsions).
  • Drowsiness.
  • A change in behaviour.
• Skin - TB can cause certain rashes, including erythema nodosum - a red, lumpy rash on the legs - or lupus vulgaris which gives lumps or ulcers.
• Spread to many parts of the body - this is called miliary TB, and can affect many organs, including lungs, bones, liver, eyes and skin.

Precautions

f you have active tuberculosis (TB) in the lung, you can infect other people until you have taken the correct treatment for two weeks. After that, normally you will not be infectious (but you should continue with the treatment). During the first two weeks of treatment, you will be advised to stay at home (or stay in your room if in hospital) and avoid contact with anyone who has poor body defences (immune system). This includes people with HIV, those taking chemotherapy medicines, or young babies.

Sometimes extra precautions are needed - for example, if your TB is thought to be very infectious or resistant..

Stopping the spread of tuberculosis is the most effective way of preventing its incidence among children. All adults who work with children should be screened regularly. In many communities, children are tested when they reach their first birthday and then at one-to-three year intervals throughout the school years. The medical profession is divided on the issue of screening; some physicians believe that the screening should be focused in areas of common occurrence or within high-risk populations such as foreign-born children. The practice of relying on parents to report results of the skin testing has also come under criticism from some members of the medical community.

While a vaccine for TB does exist (Bacille Calmette-Guerin or BCG vaccine), it is not widely available in the United States and has had conflicting reports about its efficacy. Being inoculated with BCG vaccine does not always prevent infection with the disease.

Read more: http://www.healthofchildren.com/T/Tuberculosis.html#ixzz56rvv8QLu