1992Corolla

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you omfs residents allowed to take pictures of some of your surgeries? my dad has tons of slides from his res of the things he saw, just wondering.

if so can you post them?
 

scalpel2008

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i have a ton of pics but don't know of the best way to post them, the files are too large to post as attachments
 

aphistis

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scalpel2008 said:
i have a ton of pics but don't know of the best way to post them, the files are too large to post as attachments
Can you post them to your school's web space? You could link them from here.

Otherwise, I can't think of anything that wouldn't require more work than it's worth.
 
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OK, I'll start. This is a laceration above the right eye. Motorcycle crash and must have skidded through a field...you can see all the grass in the wound:



Here's another after I washed out the grass. I'm holding the supraorbital nerve in the forceps. That's his eye at the bottom of the picture:

 

Doggie

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toofache32 said:
OK, I'll start. This is a laceration above the right eye. Motorcycle crash and must have skidded through a field...you can see all the grass in the wound:



Here's another after I washed out the grass. I'm holding the supraorbital nerve in the forceps. That's his eye at the bottom of the picture:


And then Eddie exclaims, "Those pictures are out of focus!" :smuggrin:
 

scalpel2008

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don't you just love lid lacerations! mmmm, my favorite.
 

scalpel2008

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ok, here is some stuff that I've seen along the way, some as an intern some as an upper level. the first 3 pictures show exactly why it takes 6 years. i also have a lot of trauma stuff that i don't know if you all want to see. warning: orthodontists, please view at your own discretion.

http://home.kc.rr.com/kcoms/
 

scalpel2008

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north2southOMFS said:
Pablo, who is doing your cancer work now?




PS. My favorite are the tooth ext. photos.....very atraumatic.
there in lies the problem. looking for a cancer guy again. hopefully we get someone.
 

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scalpel2008 said:
ok, here is some stuff that I've seen along the way, some as an intern some as an upper level. the first 3 pictures show exactly why it takes 6 years. i also have a lot of trauma stuff that i don't know if you all want to see. warning: orthodontists, please view at your own discretion.

http://home.kc.rr.com/kcoms/
That is incredible. I absolutley take my hat off to you guys.
 

scalpel2008

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Not to discount the efforts of the trauma, tmj, craniofacial, and other fellows, but I admire the guys who go through cancer fellowships and are able to produce phenomenal results, giving OMS and the dental community a well deserved place in head and neck surgery. Amongst all of that, I am just a resident helping out and often times holding sticks, but you'll be surprised how much you learn even when you don't cut sometimes. In taking care of these patients post operatively, you learn to obsess with details to the point of being borderline OCD, with the ultimate goal of improving the outcome.
 
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Dr.Brutus said:
That is incredible. I absolutley take my hat off to you guys.
I second that. Those pics are crazy.
 

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scalpel2008 said:
there in lies the problem. looking for a cancer guy again. hopefully we get someone.
Who was your staff for those photos? What program are you in? Those are some of the cleanest dissections I've seen. Of course, we always pretty things up for our photos as well.
 

scalpel2008

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toofache32 said:
Who was your staff for those photos? What program are you in? Those are some of the cleanest dissections I've seen. Of course, we always pretty things up for our photos as well.
kansas city. you have a PM for the rest.
 

kvip

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I second that. Those pics are crazy.
I third that. Even though I am just a pre-dent, I saw an elective open heart surgery once while I was working in the hospital but that was nothing compared to some of the pics i saw in this thread . Keep doing the good work. :thumbup: :thumbup:
 
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1992Corolla

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YES! Exactly what I wanted to see. My dad has a slide of a complete mandiblectomy.

I will have to scan it when I move to phila. and get my computer out of the storage shed.

It shows the patient pre op, then during, then the third is a hand holding the whole mandible, chin skin and all. It was a bad case of oral cancer caught unfortunately in the late stages and everything had to go.

It's amazing what you guys can do (or what you get to watch... ;) )
MORE MORE MORE
 

esclavo

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I forgot how to post pictures on SDN, but I have 5 lacerations from this week that have been a real blast.

1. Motorcycle accident, swerved to miss a deer and ate the windshield of his bike. Found by his mom and dad in a ditch gully next to a cornfield. Glasgow of 15, little etOH, broken wrist and a BEAUTIFUL LACERATION!

The bike windshield must have hit just inferior to the anterior nasal spine so the laceration began at the base of the nose and proceeds posterior to the coronoid process. Knocked out all the teeth in his premaxilla and tore all the way to the coronoid, 3mm inferior to stensons duct bilaterally (lucky bastard) and then the laceration on one side propogated to the border of the mandible. It essentially created a new oral opening that ended up being 35 cm of full thickness (4 layer closure) starting from the oral mucosa and working out to the cuticular layer. He almost completely transected the anterior half of his tongue (hanging on by 3 little threads. It looked like he had 2 mouths! A little lid laceration and forhead lac. He also had a mandible fracture and bilateral ZMC's. Amazingly his piriforms and his ptergoid's were solid so his midface didn't move. If the windshield would have went superior to the nasal spine I think he'd had a LFI/II. I sewed forever. Corn, bugs, dirt, vegetation in that wound. PM me your email address and I'll forward you the pics.
 

north2southOMFS

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scalpel2008 said:
Not to discount the efforts of the trauma, tmj, craniofacial, and other fellows, but I admire the guys who go through cancer fellowships and are able to produce phenomenal results, giving OMS and the dental community a well deserved place in head and neck surgery. Amongst all of that, I am just a resident helping out and often times holding sticks, but you'll be surprised how much you learn even when you don't cut sometimes. In taking care of these patients post operatively, you learn to obsess with details to the point of being borderline OCD, with the ultimate goal of improving the outcome.

I agree, Dr. G always tells us that he can teach a monkey to cut(hence omsres, txoms, and omscardsfan), its knowing when to operate and how to heal them after the surgery that takes the training. :thumbup:
 

scalpel2008

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esclavo said:
I forgot how to post pictures on SDN, but I have 5 lacerations from this week that have been a real blast.

1. Motorcycle accident, swerved to miss a deer and ate the windshield of his bike. Found by his mom and dad in a ditch gully next to a cornfield. Glasgow of 15, little etOH, broken wrist and a BEAUTIFUL LACERATION!

The bike windshield must have hit just inferior to the anterior nasal spine so the laceration began at the base of the nose and proceeds posterior to the coronoid process. Knocked out all the teeth in his premaxilla and tore all the way to the coronoid, 3mm inferior to stensons duct bilaterally (lucky bastard) and then the laceration on one side propogated to the border of the mandible. It essentially created a new oral opening that ended up being 35 cm of full thickness (4 layer closure) starting from the oral mucosa and working out to the cuticular layer. He almost completely transected the anterior half of his tongue (hanging on by 3 little threads. It looked like he had 2 mouths! A little lid laceration and forhead lac. He also had a mandible fracture and bilateral ZMC's. Amazingly his piriforms and his ptergoid's were solid so his midface didn't move. If the windshield would have went superior to the nasal spine I think he'd had a LFI/II. I sewed forever. Corn, bugs, dirt, vegetation in that wound. PM me your email address and I'll forward you the pics.
what was your sequence on this patient from the ED eval till whatever repairs have been done? Sounds like you have some good midface vertical buttresses to reestablish facial height. And did you suture that in the ED? esclavo, for the love of god! :eek:
 
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1992Corolla

1992Corolla

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These pictures were sent to me by esclavo:
Esclavo said:
I forgot how to post pictures on SDN, but I have 5 lacerations from this week that have been a real blast.

1. Motorcycle accident, swerved to miss a deer and ate the windshield of his bike. Found by his mom and dad in a ditch gully next to a cornfield. Glasgow of 15, little etOH, broken wrist and a BEAUTIFUL LACERATION!

The bike windshield must have hit just inferior to the anterior nasal spine so the laceration began at the base of the nose and proceeds posterior to the coronoid process. Knocked out all the teeth in his premaxilla and tore all the way to the coronoid, 3mm inferior to stensons duct bilaterally (lucky bastard) and then the laceration on one side propogated to the border of the mandible. It essentially created a new oral opening that ended up being 35 cm of full thickness (4 layer closure) starting from the oral mucosa and working out to the cuticular layer. He almost completely transected the anterior half of his tongue (hanging on by 3 little threads. It looked like he had 2 mouths! A little lid laceration and forhead lac. He also had a mandible fracture and bilateral ZMC's. Amazingly his piriforms and his ptergoid's were solid so his midface didn't move. If the windshield would have went superior to the nasal spine I think he'd had a LFI/II. I sewed forever. Corn, bugs, dirt, vegetation in that wound. PM me your email address and I'll forward you the pics.
LACERATION 1

LACERATION 2

LACERATION 3

FIXIN 1

FIXIN 2

FIXED 2

Thanks Esclavo for a job well done! Those pictures were very interesting.
 
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^^^^^^^^^^
I wondered how in the world will all his intriquite facial muscles heal?

Does someone who suffers an injury like this suffer from limited motion of movement with his lips, mouth and cheeks?
I would think so , but can only time tell or is this something to recover from?

Also what will the scarring be like?

I imagine he will have a nice scar, but I have seen other cases like this with major facial trauma and they seem to recover to the point where they have minor 'unnoticable scars until your up close' damage.
 

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I am sure that someone will post a GSW here. I have four that are extremely graphic. The problem is that closure of the GSW isn't very satisfying because the avulsive compenent is so huge. The cool thing of GSW is the reconstruction. I like the soft tissue injuries that have all the pieces there but you have to figure out how to fix it.

I wish I had a picture of the guy when I told him to smile before the repair. You could see his buccinator, rizoris, and zygomaticus muscles pull but they had no insertion on the modiolus (sp) therefore the lips were quite static. You could see his muscles very well and the obicularis oris was pretty much intact so when I got to the corner of the mouth I just made sure to get good muscular closure at that location. I've repaired a lot of tongues but rarely have put in deep muscular stitches (except in partial glossectomy cases). This is one guy I had to use a lot of 3.0 chromic in the muscle. At the end of the case his tip on one side was very dusky. It looks okay now but I was a little worried for a little bit. I ask him to smile now and it is amazing his does have somewhat of a dynamic lip. I was hoping to get to do a sialodochoplasty on him, but no such luck. I cannulated the ducts and they didn't appear to be injured.
 
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GSW = gun shot wound...thanks google.

Can you send those to me too Esclavo?
ben @ ckjohnson DOT com
 

Reconabe

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1992Corolla said:
GSW = gun shot wound...thanks google.

Can you send those to me too Esclavo?
ben @ ckjohnson DOT com

I would like those graphic ones as well, if you are sending them out. [email protected]
 

esclavo

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no mas. All you dentites need to focus on pits and fissures and perykamata. I'm starting to feel like the guy over 21 who's being asked to buy booze for the high schoolers. When you are mostly through dental school and accepted into residency, then you'll be able to begin to fully appreciate and understand the dynamics that the pics reveal! For now, it is just "intellectual pornography", "eye candy", for the "shock factor"......
 
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esclavo said:
no mas. All you dentites need to focus on pits and fissures and perykamata. I'm starting to feel like the guy over 21 who's being asked to buy booze for the high schoolers. When you are mostly through dental school and accepted into residency, then you'll be able to begin to fully appreciate and understand the dynamics that the pics reveal! For now, it is just "intellectual pornography", "eye candy", for the "shock factor"......
I guess you're right in a way. I'll have to deal with my withdrawels by sitting outside the ER with some binocs... :D Thanks for the previous photos though. Now I gotta get back to reviewing the krebs cycle :sleep:

:D
 

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Scapel2008 Im unable to pull up those photos from your link. Is there anyway else that I could see those? Or any other place to check them out? Thanks
 

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Nothing like a mandibular swing and total glossectomy:

 
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IcedOMFS

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Nothing like a mandibular swing and total glossectomy:


What's with the green towels and old-skool fabric gowns? Those things get so damn hot...

Where in the hell are you working, toof? Venezuela? Guess they haven't caught on to the blue disposable dealies yet?

Oh... PS... Sexy pic. I think I came in my pants a little...
 

toofache32

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What's with the green towels and old-skool fabric gowns? Those things get so damn hot...

Where in the hell are you working, toof? Venezuela? Guess they haven't caught on to the blue disposable dealies yet?

Oh... PS... Sexy pic. I think I came in my pants a little...
I guess reusable is cheaper.
 

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I know many of these posts are old (2006/2009) but still very informative. It would be nice if any current residents uploaded/linked new photos.

Thank you
 

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+1 I'd like to see some new photos as the current links don't work.
 

tx oms

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I agree, Dr. G always tells us that he can teach a monkey to cut(hence omsres, txoms, and omscardsfan), its knowing when to operate and how to heal them after the surgery that takes the training. :thumbup:
Funny thing, we're finishing up a paper on monkeys doing surgery. You're actually the subject of this prospective study.
 
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