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Medical Investigations: Oral and maxillofacial surgery

Oral and maxillofacial surgery is surgery to treat many diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral (mouth) and Maxillofacial (jaws and face) region. It is an internationally recognized surgical specialty. In most countries around the world, including the United States, Canada and Australia, it is a recognized specialty of dentistry; in others, such as the UK, it is recognized as a medical specialty.

Regulations

In several countries oral and maxillofacial surgery is a speciality recognized by a professional association, as is the case with the American Dental Association, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Dentists of Canada, Royal Australasian College of Dental Surgeons and the Brazilian Federal Council of Odontology (CFO).

In other countries oral and maxillofacial surgery as a specialty exists but under different forms as the work is sometimes performed by a single or dual qualified specialist depending on each country's regulations and training opportunities available.

Summary

An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, skull, as well as associated structures.

Depending upon the jurisdiction, maxillofacial surgeons may require training in dentistry, surgery, and general medicine; training and qualification in medicine may be undertaken optionally even if not required.

Oral and maxillofacial surgery is widely recognized as one of the specialties of dentistry. In the UK however, maxillofacial surgery is a medical specialty requiring both medical and dental degrees, culminating in an appropriate qualification (e.g. Fellow of the Royal College of Surgeons, FRCS, in the UK). All oral and maxillofacial surgeons however must obtain a university degree in dentistry before beginning residency training in oral and maxillofacial surgery.

They also may choose to undergo further training in a 1 or 2 year subspecialty Oral and Maxillofacial Surgery Fellowship Training in the following areas:

• Head and neck cancer – microvascular reconstruction
• Cosmetic facial surgery
• Craniofacial surgery/Pediatric Maxillofacial surgery/Cleft Surgery
• Cranio-maxillofacial trauma
• Head and neck reconstruction (plastic surgery of the head and neck region)
• Maxillofacial regeneration (reformation of the facial region by advanced stem cell technique)

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing in a few EU countries[clarification needed]. However, the public funds spent for 14 years of training are of a major concern for governments. Integrated programs are becoming more available to medical graduates allowing them to complete the dental degree requirement in about 3 years in order for them to advance to subsequently complete Oral and Maxillofacial surgical training.

Surgical procedures

Treatments may be performed on the craniomaxillofacial complex: mouth, jaws, face, neck, skull, and include:

• Dentoalveolar surgery (surgery to remove impacted teeth, difficult tooth extractions, extractions on medically compromised patients, bone grafting or preprosthetic surgery to provide better anatomy for the placement of implants, dentures, or other dental prostheses)
• Surgery to insert osseointegrated (bone fused) dental implants and maxillofacial implants for attaching craniofacial prostheses and bone anchored hearing aids.
• Cosmetic surgery of the head and neck: (rhytidectomy/facelift, browlift, blepharoplasty/Asian blepharoplasty, otoplasty, rhinoplasty, septoplasty, cheek augmentation, chin augmentation, genioplasty, oculoplastics, neck liposuction, lip enhancement, injectable cosmetic treatments, botox, chemical peel etc.)
• Corrective jaw surgery (orthognathic surgery), surgical treatment and/or splinting of sleep apnea, maxillomandibular advancement, genioplasty
• Diagnosis and treatment of:

• benign pathology (cysts, tumors etc.)
• malignant pathology (oral & head and neck cancer) with (ablative and reconstructive surgery, microsurgery)
• cutaneous malignancy (skin cancer), lip reconstruction
• congenital craniofacial malformations such as cleft lip and palate and cranial vault malformations such as craniosynostosis, (craniofacial surgery)
• chronic facial pain disorders
• temporomandibular joint (TMJ) disorders
• Dysgnathia (incorrect bite), and orthognathic (literally "straight bite") reconstructive surgery, orthognathic surgery, maxillomandibular advancement, surgical correction of facial asymmetry.
• soft and hard tissue trauma of the oral and maxillofacial region (jaw fractures, cheek bone fractures, nasal fractures, LeFort fracture, skull fractures and eye socket fractures).

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Video: A Museum Of Medical Horror - Mutter Museum Documentary Film

Medical Investigations: It thins the cold?

Put the heat too high can become obese. The explanation is simple. When the thermometer reads 25 ° C to 30 ° C ambient temperature, our body does not need to consume energy.

But when down to 17 ° C, the body tends to produce brown adipose tissue, a good fat that burns energy and glucose and produces enough heat to maintain body heat, as unveiled a study by the Medical Center of the University of Maastricht, in the Netherlands.

Apparently, when the cold gets worse, the body launches a series of processes to counter it. This may involve spending up to 30% of the energy budget of the body. And the more fat devote to it, the less likely we suffer diabetes, overweight or obese.

In sum, to keep the line in addition to eating right and exercising, scientists recommend accustomed to spending more time at moderately low ambient temperature. So much so that the endocrinologist Paul Lee and colleagues at the National Institutes of Health in the United States have come to the conclusion that it would suffice to drop a few degrees for central heating in buildings heated during winter nights to stop him the global obesity epidemic.

Medical Investigations: Serves body fat as 'airbag' in an accident?

According to Richard Kent, an expert in biomechanics at the University of Virginia (EE. UU.), The belief that the body fat protects us in case of accident is unfounded. In fact, look a good handles only reduces the risk that the head is struck.

By contrast, the belt becomes more inefficient, as it is designed to prevent movement of the body by holding the bones. Kent found that bulky -dummies- test dummies and slipped out of their seats, while the skinny remained motionless during impact.

In addition, vehicle airbags are also more effective in thin people. A few years ago the surgeon at the University of Washington Charles Mock showed that people who weigh between 100 and 119 kilos are 2.5 times more likely to die in an accident even if the air bag safety inflates who do n

Medical Investgations: Why the nerves make us puke?

Vomiting, a phenomenon also known as emesis, is controlled by an area located in the medulla, in the brainstem, which also is known as vomiting center. This region receives information that sometimes induces the body to perform that action.

For example, you may experience a feeling of nausea and even arcades from certain data sent from the cerebral cortex, like watching a repulsive image on a traumatizing event, but also from the brainstem, which tells the moving and would be responsible for dizziness in transportation. It happens with those coming from the vagus nerve, which sends information about the digestive system, so that vomitemos if we eat something supposedly toxic.

Anxiety can cause vomiting reach the center of negative signals related to any of the above aspects. This is sometimes nerves cause us bad feelings of balance, digestive and often, cognitive, related to unpleasant thoughts that passed through his head.

Medical Investigations: What is the role of carbohydrates?

We are used to that specialists recommend us to include carbohydrates in our diet, as they are the staple food in all societies of the world. But sometimes, like with other nutrients, we do not question what they really are and what are the benefits for our body. And it is essential that we know what we eat.

Carbohydrates are mainly based energy intake. According to experts from the Heart Foundation, "Glucose is the only energy source for the brain, which consumes about 100 grams per day". The so called carbohydrates serve as energy reserves in the form of glycogen, which quickly mobilized to generate glucose when needed.

But it does not end here. They also have a protein-sparing effect, and work to prevent the formation of ketone bodies. These bodies are nothing but debris that occur when the body uses fat instead of sugar for energy. Furthermore, part of the connective tissue and nervous and important molecules such as DNA or ATP.

Contrary to what one might think, fruits and vegetables are foods with fewer carbohydrates. Instead, cereals, sugars, tubers and pulses having a high presumed saccharide content. Experts advise consume an amount of 200-300 grams per day, but how can you measure this? The Foundation ensures that if consumed daily for three to five servings of food hidrocarbonatos, best expectations are achieved.

What is clear is that they should provide 50-55 percent of total calories in the diet, otherwise, there would be failing in our right regulatory balance of power.

Medical Investigations: Why produce much stress tests?

About three in ten students take notes under their knowledge because of stress and brain lock that grips during exams.

All this burden is largely due to performance anxiety: when we will evaluate our body reacts to respond in the best way possible; the autonomic nervous system is activated and adrenaline is released.

It is an adaptive mechanism that has been functional for millennia, but today, when in most cases what we are asked is intellectual performance, alertness entry can harm us. Although some tension improves outcomes, beyond a certain level of stress, increased pressure decreases our mental performance.

The reviews also stressed by altering the daily rhythm. As recalled psychologist at the University of Deusto Rosario Morejon, an expert on stress in education, these tests require us to cognitive overload for the brain is not ready, vital intensive rehabilitation for a period that takes several weeks, and abandoned for lack of time relaxing habits such as exercise, travel and reading.

And get nervous in front of an artificial situation like this is inevitable. Professor Arturo Barraza, University of Durango, found that 96.8% of students suffer a sharp increase in anxiety in exam periods.

But how do you cope? Psychologists recommend changing the focus -take the test as a challenge and not as a obligation-; relaxation exercises about 20 minutes a day at least; use stop thinking, to avoid continuous and useless anticipation of problems, like "what if I stay white?"; and organize study time balancing work and time off.

Medical Investigations:What is the Stockholm Syndrome?

On August 23, 1973, in the Swedish city of Stockholm, there was a robbery with hostages. Jan Erik Olsson, an inmate permission entered the bank Kreditbanken Norrmalmstorg in the city center. Being alerted the police, two officers arrived almost immediately. The robber wounded one of them and sent the second sit and sing. Olsson had taken four hostages and demanded three million Swedish kronor, a vehicle and two guns.

The government was forced to collaborate and granted him out there at Clark Olofsson, friend of the offender. Thus began the negotiations between robber and police. To the surprise of all, one of the hostages, Kristin Ehnmark, not only showed their fear of police action to end up in tragedy but came to resist the idea of ​​a possible rescue. He said, she felt safe.

After six days of retention and threats kidnapper, whose side was the Ehnmark own, police decided to act and when they started gasearles, criminals surrendered. No one was injured. Both Olsson and Olofsson were convicted and sentenced, but later the charges against Olofsson, who reoffend withdrew. Jan Olsson, however, after serving 10 years in prison would fully rehabilitated prison and maintaining a legion of fans.

Throughout the trial, the hostages were reluctant to testify against those who were their captors and even today say they were more terrified by the police that the robbers who held them for almost a week. The criminologist Nils Bejerot coined shortly after and as a result of that case, the term Stockholm Syndrome to refer to hostages who feel this type of identification with their captors.

But the case of Stockholm bank is not the only thing that has occurred. In 1974, Patricia Hearst, granddaughter of media mogul William Randolph Hearst was kidnapped by the Symbionese Liberation (SLA) Army. After donate six million dollars to the family terrorist organization, not heard from her. Two months later she was photographed, assault rifle in hand, during a robbery of a bank SLA. He had joined the organization and changed its name to Tania.

The Bejerot itself states that this syndrome is more common in people who have suffered some form of abuse, hostage, cult members, psychologically abused children, victims of incest or prisoners of war or concentration camps. Cooperation between the hostage or victim and the perpetrator is in large part because they share the common goal of emerge unscathed from the incident. The no control over the situation by the kidnapped leads apparently to try to fulfill the wishes of their captors, on the other hand, are presented as the only ones who can prevent a tragic escalation of events. Thus, identification of the victim with the motives of the perpetrator and appreciation to the captor that sometimes takes extreme situations occurs.

Medical Investigations: Factors that weaken the quality of semen

What external factors can affect semen quality and impair the ability to fertilize in men? A study conducted by a team of researchers from the National Institutes of Health and Stanford University in California (USA), has unraveled those causes related to our lifestyle that outside of those already studied as the stress, causing this result. The findings have been published in the journal Fertility and Sterility.

"Male infertility plays an important role, and our goal is to explore the influence of environmental factors and health status in semen quality," says Germaine Buck Louis, who led the study.

Semen quality is based on the number, shape and movement ability of spermatozoa as well as other factors. So experts with the participation of more than 500 couples with an average of 31.8 years of age, white and college. The couples had stopped using contraception and follow them all was held for 12 months.

Male participants, apart from providing a semen sample were subjected to several interviews about their reproductive history, lifestyle, occupation and health. The following results during this period revealed, among other things, that 13% of men whose work requiring great physical effort had a low sperm count, compared to 6% whose work did not require force.

Additionally, those who had high blood pressure, high cholesterol or diabetes also had a lower percentage of sperm compared to those without these characteristics of health. Likewise, those taking drugs, 15% had sperm counts below what is considered normal, 39 million per milliliter.

In all, the research concludes that have a physically demanding job, taking several medications and suffer high blood pressure are some of the factors that can decrease sperm quality and hinder the desired design by the couple.

Medical Investigations: Memory

In your native language, your brain recognises – and endows with meaning – any conceivable subset of 50,000+ words within fractions of a second. That is in stark contrast to what you will experience with subsequent languages where initially nothing ever happens in milliseconds. Imagine that, during your first trip to Paris, a friendly local takes you on a two-hour stroll from Notre Dame to the Louvre, then northwards up to the Sacré-Cœur, and, finally, down to Pigalle. If I put you back at Notre Dame a few months later, you would probably find your way to Pigalle alone, recalling places, streets, crossroads, shops, and buildings. It is hard to believe that this wealth of information is approximately equivalent to learning 20 miserable words. Why does it take adults so long to learn languages while young children seem to do so whilst playing, laughing and having a great time? Do we all, shortly after infancy, suffer a subtle form of partial Alzheimer’s disease? Or are adult brains tuned to find their way in urban jungles rather than in word jungles?

Let’s take a glass. Imagine that I put my finger on it and ask you what it is. You would answer ‘glass’, instantly, without hesitating. The word pours out of your mouth as water pours out of a spring. It does so because ‘glass’ is woven into your brain in many different ways: you have a mental image of a glass; you have a memory trace for the spoken word; you have a memory trace for the written word; you know that the word has 5 letters, that it starts with a g and ends with an s; you have a motor recipe for pronouncing the word; and, on demand, you can recall hundreds of memories associated with the word – glasses raised to celebrate births, marriages, and anniversaries, or a glass smashed against a wall. ‘Glass’ is embedded in a dense web of events and things in time and space. Figure 6.1 shows one such web. Any single of your 50,000+ native words is intertwined in multiple locations of your brain, floating in a sea of meanings, facts, and emotions. As soon as you wake up in the morning, all brain words go into stand-by mode, waiting to jump into consciousness as soon as their equivalents – written or spoken words – enter the brain via your eyes or ears. Grown over decades, this vast network of word webs is the most precious asset of your life.

To manage word webs – and other tasks, of course – your brain relies on complex and compact machinery. First, it contains around 100 (1011) billion neurones, which are the main information-processing cells. Second, these neurones are connected to neurones either in the vicinity or far away. In young adults, the long distance fibre tracts total around 176,000 km in length – that is roughly half way to the moon.

Third, each of the 1011 neurones is linked to other neurones by up to 10,000 so-called synapses. These are highly specialised interfaces where information is passed from axons – slim extensions that carry the electric signals generated by the neurones – to dendrites, which are highly branched tree-like structures that receive the signals originated in other neurones

(Figure 6.2).

Figure 6.2. A single neurone, its dendrites and its multiple synapses (orange dots).

The resulting picture is majestic: one billion synaptic connections in a single cubic millimetre of specialised brain tissue, up to 1000 trillion (1015) in a human brain. One thousand TeraSynapses – that is the number of stars in ten thousand Milky Ways.

Yet the most surprising detail is still to come: synapses are not carved in stone. They come and go as their support, so-called dendritic spines, appear and disappear. These spines are tiny protrusions from a neurone’s dendrite. If you teach a mouse to reach out with its forelimb to a single seed, dendritic spines form as rapidly as within one hour. Most of these new spines will regress again, but some are preserved and stabilised during subsequent training. The resulting change in circuitry is most likely the anatomical substrate for long-term memory storage.

The resulting plasticity of the brain can even be observed macroscopically, for example in London, taxi drivers from pre-

GPS times who developed a hypertrophy of the brain region that is involved in spatial orientation, or in violin players who have an enlargement of the left hand representation in the sensorimotor cortex.

The rate of spine erosion is astonishing. Most newly formed spines vanish within days, and only a fraction persists for months. Using 20 percent of all the oxygen you breathe, your brain is constantly sorting out newly received information, enforcing what is important and discarding what is irrelevant.

The extent of the deconstruction going on in your brain was nicely shown by 19th century experiments that measured the time of learning – and subsequent forgetting – of chains of 2,300 nonsense consonant-vowel-consonant syllables such as KOJ, BOK, and YAT. The results were sobering. After 24 hours, 70 percent was gone (Figure 6.3). Happily, you will learn meaningful word pairs rather than nonsense syllables, for example, agua–water, vino–wine, queso–chesse, and should therefore obtain better results after 24 hours. However, at Day 31, you might not perform much better than the memory pioneers more than 100 years ago. Brain physiology isn’t prone to instant word learning.

In word jungles, progress is slow.

In order to protect young spines from erosion, schedule multiple training sessions. You will note that, before getting fixed into lifelong memory, words pass subsequent degrees of knowing. At the weakest stage, you don’t even remember that you have seen a word; however, you would recognise it when presented in a list of words. Later, you would say that you once knew a word, but cannot remember it. At a subsequent stage, a word would be on the tip of your tongue, yet decline to come out. Finally, you remember it, first after seconds and then milliseconds.

Figure 6.3. Forgetting curve. Adapted from Hermann Ebbinghaus, Memory: a contribution to experimental psychology, 1885/1913.

For our immediate purposes, we will define knowing a word as successful recall after one month of non-exposure. Only occasional words will get there after the first encounter. The vast majority –alas! – will have to be subjected to the long process of multiple rehearsals through reading, hearing, or conscious repetitions.

Never forget: baby memory traces are volatile. Imagine your word brain as a castle protected by high walls and ruled by the lord of the castle, who has issued unambiguous instructions to the sentries at the gate: no entry without multiple petitions and repetitions! Memory’s suspicious gatekeepers want convincing evidence that a word deserves residence in lifelong memory. Be prepared to come back as many as 5, 10, or even 20 times, to plead the cause for every single word. Take comfort from the idea that subsequent learning rounds require less time and produce better results, allowing the learning sessions to be spaced out. If you meet a word for the first time on Day 0, repeat it on Day 1, 3, 6, 10, 17, and 31.

Figure 6.4. Learning curve (red), constructed from truncated forgetting curves.

Dark blue: Initial decline in memory performance.

Light blue: Long-term result without further repetition.

Green: Repetition putting the retention rate back to 100 percent.

Figure 6.4 illustrates these ‘spaced repetitions’ and where they will take you. Be prepared that the sum of all the repetitions may total around 4 to 6 minutes per word.

We realise that the word learning is hopelessly inadequate to describe what you are going to do. First, learning does not reflect the subsequent degrees of knowing. Second, learning implicitly suggests forgetting. How many things did we once know and have since forgotten? What is fine for physics and higher mathematics, most of which is irrelevant in ordinary life, is intolerable for languages where you need every bit of information for the rest of your life. I am therefore reluctant to tell you that you learn words when, in fact, I mean that you need to store them in your word brain in a fairly definitive way. You must etch new words and carve and pound and burn and nail them. The alternative for learning should express that a word will stay in your brain for decades: it may corrode and slowly become weaker, but it will nonetheless resist and surrender only to arteriosclerosis. Let’s abandon learning, which is too cushy, and adopt something more physical. Let’s say nailing. The definition of nailing includes the three steps of learning, repeating and controlling.

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