DO YOUR HANDS GIVE AWAY YOUR AGE?

 

 

Do your hands look old, dark and wrinkled? They are aging with you but they need not give away your age a lot quicker than your face.  If you don't have a youth-preserving plan for the delicate, oft-abused skin and nails on your hands, it'll be a dead giveaway of your age.

 

How are the hands aging?

1.      Age spots: The funny thing about age spots is that they actually have nothing to do with age: Age spots are the result of sun exposure. Short of wearing gloves 24/7, you should be smoothing on a dime-sized dab of hand cream with SPF 30 before heading out the door each day—and reapplying after you wash your hands or every two hours if you're exposed to even a little sunlight. Night application of 2% hydroquinone

2.      Crumpled skin: If the backs of your hands are starting to get a crumpled look reminiscent of gift bag stuffing, use a prescription retinoid cream to improve texture and jumpstart the growth of thickening collagen. Topical application of  lotion containing a retinol or glycolic acid can help.

3.      Prominent veins: Lasers address this problem best and topical applications are not of much use. Sclerosants too are useful.

4.      Scaly skin: Nothing about dry, scaly skin says "young and healthy." Return them to smooth-and-plump status overnight with this quick pre-bed routine:

·        First, slough off rough, dead skin with a gentle scrub

·        then create an all-night moisture mask by smoothing on a glycerin and plant oil-containing hand cream like Elovera Moisturizing Cream

·        cover hands with plastic wrap and putting cotton gloves on top (skip the plastic and you'll just end up with really well moisturized gloves).

5.      Stained nails: If your nails are turning yellow or brown and are painful, then this is a fungal infection. If your doctor rules out fungal infection, you can relax, as the discoloration is likely a harmless side effect of some medication or wearing dark polish. Run your nails with a lemon wedge, just like you would when you're rubbing off nail polish (the natural fruit acids will lighten the nail bed), or soaking in denture cleaner for 15 to 20 minutes to remove the stains. Also make sure to apply a base coat before you reapply your favorite oxblood lacquer.

6.      Brittle nails: Water or chemical exposure, seasonal weather changes, and even genetics, can all lead to brittle, breaking nails. But the right supplements can help. Taking a 2.5 mg dose of the B vitamin biotin improves nail strength and reduces brittleness after six to nine months.

7.      Outdated manicure: Science is constantly changing and your idea of manicure may be outdated. Seek professional help once in a while.

8.      Give up smoking: Smoking tobacco hastens atherosclerosis and hands, and particularly the fingers, being terminal organs are least vascularized and lose the youthful turgor.

How to prevent hand aging?

With proper care, and this handy advice, your hands will keep your age hidden for longer.   

Wash your hands correctly

Too much soap can make your hands dry and flaky, so keep these essential tips in mind:

·        Don't use antibacterial soap unless absolutely necessary. Opt for a moisturizing soap instead (Pears, Dove), such as one with jojoba oil, olive oil or aloe vera.

·        Wash your hands with warm, but not hot water - this will help preserve the natural protective layer. 

·        As opposed to electric dryers, opt for paper towels instead. 

 

Wear gloves

Hands are constantly affected by external factors such as cold, chemicals and dry air. To minimize the damage to your skin, wear gloves as follows:

·        Use leather, fur gloves or mittens for cold weather.

·        Wear rubber or latex gloves for household chores - washing the dishes, mopping floors, cleaning the bathtub etc.

·        Use cloth gloves for gardening.

 

Moisten your hands regularly

Your body needs to stay hydrated to keep each cell and tissue refreshed. Apart from crucial functions like flushing toxins from your body, water also keeps your skin healthy and hydrated from the inside. Dehydrated skin can turn brittle, weak, and thin, eventually leading to wrinkles on your hands. Your aim should be to drink at least eight glasses of water every day.

·        A good hand cream is as crucial as soap or shampoo. Keep these tips in mind:

·       Clip your nails, and purchase a vitamin E cream for the cuticles. 

·        Be sure to drink plenty of water.

·        When the Apply the cream as needed, though no less than twice a day. If your hands are dry, keep hand cream by the sink and apply it after every time you wash your hands. Pick a hand cream that contains glycerin andalpha-hydroxy acids. These are beneficial ingredients that work as humectants to attract moisture from the air to your skin. 

·        Moisturize the room air, turn on the humidifier.

·        Use Emollient - Lack of water can dry the top layer of your skin. It cracks the surface of the skin and leaves spaces between the skin cells. Emollients, or softening agents, fill these empty spaces between your skin cells and make your skin smoother.

 

Remember to scrub

Your hands need scrubbing and masks at least once a week:

·        Make a hand mask from the products you have in your fridge. Mix 20 ml. milk, an egg yolk and a tablespoon of lemon juice, applying it to your hands and letting it rest for 20 minutes. 

·        Use a mix of olive oil and sugar as a scrub.

·        If using a body scrub, apply that to your hands. 

As we age, the skin's natural exfoliation process slows down. Thus, the skin builds up dead skin cells. When we exfoliate our hands with a mild scrub we get rid of dead skin cells. It helps in turn to speed up cellular turnover while softening fine lines and wrinkles on our hands.

Use sunscreen

To protect your hands from the sun, apply a broad-spectrum, water-resistant sunscreen with SPF 30 or higher to your hands every day before going outdoors. Hyperpigmentation following sun exposure can make your hands look older than your age. But this does not occur due to aging or liver dysfunction, but rather, the effect of the sun. To avoid pigment spots do the following: 

·        Regularly apply sunscreen to your hands.

·        Citrus fruits are a good natural 'whitener,' so make a mask out of 1 tbsp lemon juice, 1 tbsp milk, and 1 tsp honey. 

Use a Retinoid at night

One of the most popular anti-ageing ingredients, retinoids are derived from vitamin A. Retinoid is also the most widely used prescription treatment for wrinkles. Retinoids can increase collagen production in the skin. They also encourage skin regeneration and promote the formation of new blood vessels. Hence, your skin appears smooth, soft, and healthy. Use it only in the night, as sun exposure after applying retinol is not recommended. Pregnant women must avoid it.

Healthy Diet

Maintain a healthy diet with vitamins, antioxidants, and omega-3 fatty acids.

Non surgical hand rejuvenation

1.      For sun spots

·         Cryosurgery (freezing)

·         Laser therapy

·         Chemical peeling

·         Microdermabrasion

·         Skin-lightening creams and lotions

 

2.      For loss of youthful fullness

·        Fillers -   Dermal fillers or soft tissue fillers can be used to reduce wrinkles. These fillers are substances designed to be injected beneath the skin surface to add volume. It also provides fullness and reduces wrinkles temporarily.

·        Fat grafting – fat is aspirated from lower abdomen or thigh and injected under the skin of hand

 

3.      Prominent veins

·        Sclerotherapy - injects a substance into the vein to destroy it. This causes the vein to disappear slowly.

·        Lasers

 

4.      Wrinkled skin

·        Chemical peel – every 1 to 3 months

·        Lasers

 

5.      Loose skin

·        Radiofrequency, a procedure that sends heat deep into the skin, can tighten loose skin. Most people need only one treatment on their hands

·        Lasers

·        Fillers

The clock won’t stop for your hands. You can take action to ensure your hands maintain your desired look and feel. As you age, remember that surgical options like laser therapy, hand lifts, and fillers are always an option to keep your hands looking young. 

WHAT DO WE DO WITH ALL THIS TRASH?

 

What do we do with all this trash? With more than 7 billion people consuming, and then disposing of, "stuff" each day, usable space for trash disposal is quickly disappearing. The World Bank estimates that 3 billion people reside within urban areas, producing more than 1.3 billion metric tons of solid waste per year. By 2025 that number is expected to have ballooned to more than 2.2 billion metric tons, forcing governments to task on a garbage problem that many major cities have yet to answer.

 

It is a global problem

It is not a problem of the developing countries only. The Megacities of the world gobble up more water and energy while producing waste astronomically each year. For poor countries, inefficient waste management accelerates the rate of disease as toxins seep into waterways, leading to irreversible environmental pollution.

London churns out too much waste and only 52% goes to recycling. London’s waste disposal companies have increased the recycling rate unburdening the landfill. London’s heavy reliance on primary and secondary industries as the backbone of its economy promotes the consumption of recycled ingredients. The city is blazing the trail in creating a thriving, resilient metro that cuts down waste significantly with a circular economy along with a solid policy framework.

The 7 million perople crammed into Hong Kong's streets produce more than 13,800 metric tons of solid waste a day. That's like tossing an Empire State Building into the waste basket every 27 days. What's worse, of that waste, 3,500 tons-worth comes from scraps of uneaten food, and finding a place to store all of that garbage has proved an insurmountable task. More than 90% of waste is exported for recycling overseas, but that is simply domping poor countries with the waste created by the rich!

One New Yorker dissipates 24 times the electrical energy of a resident in Kolkata, India while spewing 15 times equal solid waste. The city runs a tight ship with aggressive recycling projects that extend outside plastics, paper, and metals to compost food waste. 

Beijing's 20 million plus people produce more than 25,000 tons of garbage a day, a number 4,300 tons beyond what the city can process. The countryside is no better; 40,000 towns and 600,000 villages across the country could not process waste and sewage, leaving more than 300 million tons of waste unprocessed each year.  Chinese government undertook a massive effort to burn trash for energy, constructing hundreds of incinerators to chip away at its trash mountains, but that resulted in large releases of harmful pollutants like dioxin and mercury into the atmosphere.

Manila area produces more than a quarter of all of the garbage in the Philippines, to the tune of nearly 9,000 tons of solid refuse a day. What's worse, only nine of the 16 cities and municipalities that make up the metro Manila area even have a plan to handle all of that waste and 83% og garbage gets collected too.  The trash that does find its way into garbage trucks coalesces into trash cities — towering trash mountains surrounded by shanty towns patrolled by Manila's poorest. Over the years Manila has played host to some of the world's most notorious garbage mountains like Smokey Mountain.

For many years Mexico City's Bordo Poniente held the dubious title of one of the largest landfills in the world. The more than 20 million people of Mexico City's metro area dumped close to 14,000 tons of garbage into the 927 acre site each day. As a result, trash gets dumped everywhere — in rivers, canals, and especially into streets, which are often impassable thanks to the mounds of refuse left behind.

With some 26.7 million people, Jakarta is also one of the world's fastest growing cities. Jakarta produces more than 6,500 tons of waste a day. Most of that waste finds its way to Jakarta's only landfill, Bantar Gebang, a 270 acre trash behemoth that receives 6,250 tons of trash from 800 garbage trucks flowing out of Jakarta each day. The trash clogs waterways during monsoon season, before being sent out into Jakarta Bay and out to sea. 

For hundreds of years the city of Cairo has operated without efficient, government-run trash collection. Instead, for the past 70 years, thousands of trash pickers known as the Zabbaleen have gone door-to-door collecting Cairo's trash for a small fee. The trash-pickers managed to recycle nearly 90 percent of all the garbage that passed through the city, a number that exceeds most Western recycling totals. 

 

The Indian Scenario

India generates 1.7 lakh tons of waste every day. Post Swach Bharat Abhiyan, 90% of the waste is collected and over 54% is processed or treated. Almost 25% of our waste is sent to the sanitary landfills. Now, to this huge man made waste we add the construction and demolition waste, which itself amounts to 15 crore tons a year. If not disposed correctly, which is often the case, it chokes our natural drainage system and cause drains to overflow and monsoon rainwater to cause floods. According to a recent estimate our cities sit atop more than 24 crore tons of legacy waste, spread across 2,400 dumpster, seeping below the surface with every rain, and infecting our groundwater. This leak into our groundwater is called leachate. This is rich in heavy metals, organic pollutants and pathogens contained in the garbage heap. Groundwater near Delhi's Bhalswa landfill has toxic levels of lead and iron and that near Nagpur's Bhandewadi landfill has zinc, copper and cadmium 200% above safe limits. 

New Delhi's tremendous growth has spurned a tremendous growth in refuse, too. The city's solid waste production increased 50 percent over five years, to 9,200 tons of trash a day in 2007, a number that was expected to double by 2024. Three of the four landfills servicing New Delhi are already past capacity, leaving the city starving for additional landfill space. If additional space isn't found these community dumps could spill over into the streets and contribute to a pollution problem that already stretches into the Yamuna river. 

 

Landfills – a necessary evil

Landfills are necessary for the proper disposal of solid waste. They reduce the amount of waste that makes it into the environment, help to prevent disease transmission, and keep communities clean. However, landfills still have significant environmental and social impact. While landfills are a societal necessity, there are practices that can reduce the reliance on landfills and decrease their effects on the biosphere.

Environmental Impact of Landfills

·         The most pressing environmental concern regarding landfills is their release of methane gas from the decomposition of organic waste. Methane is 84 times more effective at absorbing the sun’s heat than carbon dioxide, making it one of the most potent greenhouse gases and a huge contributor to climate change. 

·         Along with methane, landfills also produce carbon dioxide and water vapor, and trace amounts of oxygen, nitrogen, hydrogen, and non methane organic compounds. These gases can also contribute to climate change and create smog if left uncontrolled.  

·         The creation of landfills typically means destroying natural habitats for wildlife.

·         While landfills are required to have plastic or clay lining by federal regulation in the U.S in India these rules are openly flounted. This can result in leachate, a liquid produced by landfill sites, contaminating nearby water sources, further damaging ecosystems. 

·         Leachate can contain high levels of ammonia. When ammonia makes its way into ecosystems it is nitrified to produce nitrate. This nitrate can then cause eutrophication, or a lack of oxygen due to increased growth of plant life, in nearby water sources. Eutrophication creates “dead zones” where animals cannot survive due to lack of oxygen. Along with ammonia, leachate contains toxins such as mercury due to the presence of hazardous materials in landfills.

Social Impact of Landfills

·         Emissions from landfills pose a threat to the health of those who live and work around landfills. A study in New York found that there is a 12% increased risk of congenital malformations in children born to families that lived within a mile of a hazardous waste landfill site.

·         Chronic exposure to leachate contaminated water can cause gastroenteritis, neurological diseases and cancer. 

·         Large landfills, on average, decrease the value of the land adjacent to it. Te quality of life suffers in this region.

·         Landfills bring hazards such as odor, smoke, noise, bugs, and water supply contamination.

·         Minority and low-income areas are more likely to find themselves home to landfills and hazardous waste sites. These areas have fewer resources to oppose the placement of these facilities. This makes them an easier target for landfill placement than higher income areas.

How to avoid landfills

·         Recycle! Continuing to recycle will keep plastic and other materials out of the biosphere and put them to further use!

·         Avoid single-use plastics. Check out this article on single-use plastics and how to avoid them.

·         Compost! Landfills lack the oxygen that compostable items need to fully decompose. By putting biodegradable items into the compost instead of the trash, huge amounts of waste can avoid the landfill.

Landfills help to keep our communities clean, but they also pose serious threats to the health of our environment. Working towards living a zero waste lifestyle will help to reduce our reliance on landfills, their impact on the environment, and their impact on human health and well-being

How do we plan ideal waste management?

It has to be a multi-pronged approach. Waste management should follow the waste hierarchy:

1.      Avoid and reduce waste at the source, starting during the design and procurement phases.

2.      Repair and reuse.

3.      Sort and collect waste separating non-hazardous from hazardous waste.

4.      Recycle.

The treatment and processing system for solid waste include window composting, vermicomposting, pit composting, bio-methanation, organic waste convertors, pelletization, material recovery facilities (MRF), waste to energy plants for electricity generation etc. The ‘waste to energy’ plants are not totally safe as they emit harmful particulate matter in far higher concentration than permissible. So, such plants in Okhla in Delhi and in Jaipur and Hyderabad are not very popular with people living nearby.

So, we should have a proper plan of waste management at every step:

Planning and monitoring

Identify the different types of waste produced, evaluate and record their quantity by volume or weight. Draw up a context-based waste management plan, including sorting, collection, transport, storage, and final disposal. Assess and use local capacities like municipal landfill, informal sector, recycling companies, incineration facilities, etc.

Avoid and Reduce

Encourage procurement and programme teams to avoid and reduce waste at early stage of the project. Evaluate the relevance of each purchase. Engage with suppliers and avoid polluting or single-use items and packaging. Encourage re-usable, recycled, locally repairable and recyclable items with a long lifespan.

Repair and Reuse

Identify items that can be repaired and re-used instead of wasted. Support the necessary infrastructure, for example repair shops, tools or internal workshop. Seek spare parts for the repair process.

Sort and collect

Use separate bins and label them to sort and collect waste. Sort, collect and label hazardous waste separately to avoid any risk or contamination. Adapt the sorting to the existing local recycling opportunities (textile, paper, metals, glass, informal and formal sectors etc). Explore opportunities to mutualise collecting and storage with other actors. Bulk waste generators like malls, hotels, hostels, hospitals must compost and segregate on site. Every ward should have its own compost and segregation site and GPS tagged bins and mobile alerts should be used to track garbage collection.

Recycle

Work with local recycling companies and create employment opportunities. Consider influencing and supporting local governments and decision-makers to improve the recycling infrastructure. Recycled products like tiles, road base material, and prefabricated blocks must be popularised.

Treatment and final disposal

Identify and use legally approved local or regional disposal channels (composting, burial, sealing, controlled landfill, incineration…). Visit the site regularly. Establish partnerships (e.g., incineration in cement plants, energy recovery opportunities) and mutualize equipment like compost pits or collaborate with other actors (NGO’s, health structures, local governments, etc.). Incineration must be disintentivised to avoid contaminating the air with particulate matters.

Staff engagement and Sensitization

Raise staff awareness across all departments and involve them in avoiding waste, sorting, reusing, choosing long lifespan items, and reducing packaging.

 

The onus of mindful waste management cannot be the sole responsibility of the government. Public engagement must be strengthened by teaching waste literacy in schools and colleges, awareness campaigns by icons of the society and celebrating champions of zero waste living.

REMEMBERING PROF. R.P. SAHI BY HIS LECTURE ON MIDLINE SWELLINGS OF THE HEAD AND NECK

 

Prof. R.P. Sahi was our teacher in the Department of Surgery in King George’s Medical College, Lucknow. He was easily the best teacher in the campus. His baritone voice was renowned for its richness, strength and unmistakable quality, making it a defining feature of his aristocratic persona and a major factor in his enduring and universal popularity. This also made him instantly recognizable and command attention every time.

 

As an undergraduate teacher he was matchless because he could sub-divide the most complex subject into easily understandable bits, and once he taught a topic it somehow got imprinted in our brain for life. There was a method in his teaching which invariably simplified problems for even the back-benchers.

 

As a resident in his unit, I found him to be an inspiring leader and an outstanding post-graduate teacher with priceless qualities of a communicator, a disciplinarian, a conveyor of information, an evaluator, a Unit manager, a counselor, a member of many teams and groups, a decision-maker, a role-model, and a surrogate parent all rolled in one. His umbrella of benevolence was so reassuring that trainees got the best opportunity to express themselves. He understood the strengths and weaknesses of his trainees and steered them towards what would be best for them. Looking back, I can understand today how important this individualized approach was in his unit.

 

Prof. Sahi was a very sought after speaker, whether in surgical conferences or on social occasions. He was invariably our first choice for C.M.E and Conference inaugurations as well as after post dinner speeches. He somehow could palpate the mood of the gathering and say exactly what the occasion demanded. When Prof. P.C. Dubey was the Head of the Department of Surgery, Prof. Sahi was entrusted with the responsibility of resident posting and academic scheduling and the Department of Surgery was the best Department of the Medical College by miles. When I was applying for my Microsurgery training fellowship in St. Vincent’s Hospital, Melbourne, he and Prof. N.C. Misra gave me some glowing recommendations.

 

After his retirement he practiced in Krishna Medical Centre and mostly spent his time in academic pursuits. He stays in Hazratganj in his old bunglow wnd enjoys his retired life to the fullest.

 

I came across a lecture he delivered to our batch in 1978 on ‘Swellings of the Head & Neck’. He taught this vast topic in two lectures ‘Midline Swellings of the Head & Neck’ and ‘Lateral Swellings f the Head & Neck’ and this is the first lecture of this series.

  

Introduction

The deep fascia of the neck splits to envelope the Sternomastoid muscles. All swellings situated superficial to it are superficial swellings and all lying deep to it are the deep swellings.

 

Thus superficial swellings at this site are like any other site:

Skin             Epidermoid or Pilar cyst          

Fat               Lipoma

Nerve          Neurofibroma                          

Vessels        Haemangioma

 

The deep swellings of the neck for the purpose of description are sub divided into midline swellings and swellings in the lateral aspect of the neck.

 

Classification by Duration of lesion

1.      Acute: Cellulites, Ludwig’s Angina, Abscess, Carbuncle, Ac. Lymphadenitis

2.      Chronic:

A.    Cystic: Branchial cyst, Thyroglossal cyst, Cystic Hygroma, Cystic adenoma of Thyroid gland, Cold Abscess, Pharyngeal pouch

B.    Solid: Lymph nodes, Submandibular salivary gland, Thyroid tumours, Cervical Rib, Carotid body tumour, Branchogenic carcinoma, Sternomastoid Tumour

C.    Pulsatile: Aneurysm of Carotid artery / Subclavian artery, Aorta, Exophthalmic goiter.

 

Classification of Midline swellings

1.      On the face:

·        Median Angular Dermoid

·        Syncipital Meningocele

·        Fronto-nasal Meningo-encephalocele

·        Lachrymal sac swellings

·        Rhinophyma

·        Symphyseal odontomes

·        Gummata

2.      Submental region

·        Sub mental lymphadenitis

3.      Between menton and Hyoid

·        Ludwig’s Angina

·        Sublingual / Midline Neck Dermoid

·        Ranula / Plunging Ranula

·        Thyroglossal cyst

4.      Between Hyoid and Thyroid Cartilage

·        Sub Hyoid bursitis

·        Osteoma of Hyoid bone

·        Chondritis / Perichondritis

·        Chondroma of Thyroid cartilage

·        Laryngocele

·        Thyroglossal cyst

5.      Between Thyroid and Cricoid

·        Lymph node on crico-thyroid membrane

6.       Between Cricoid and Supra sternal notch

·        Thyroid gland – Goitres

7.      At Supra sternal space of Burns

·        Cold Abscess

·         Lymph nodes

·        Ectopic Thyroid

·        Supra sternal bursitis

·        Neurofibroma

·        Aneurysm of Arch of Aorta

 

Median Dermoids: Can be present at the midline either on the vault or on the floor of mouth or neck. They usually contain skin elements – sebum, hairs etc. They may scallop the skull bones and rarely have intra cranial extension through a gap in the skull. Treatment is excision and repair.

 

Fronto nasal Meningocele / Meningo-encephalocele: Meningoceles are brilliantly trans illuminent, cystic swellings, getting tense on coughing, crying or jugular pressure. Meningomyloceles have ectopic brain tissue in them and so are not trans illuminent. The inter orbital distance is widened – hypertelorism and there are cross fluctuations between it and the fontannele. CT scan demonstrates the gap in the skull and the treatment is excision, replacement of herniated contents, and repair of the bony gap by bone grafts and surgical correction of hypertelorism.

 

Lachrymal sac swellings: These are in the medial canthus of eye, usually inflammatory, and cause by blockage of naso-lachrymal duct with resultant epiphora. Treatment is initially conservative and if unsuccessful a DCR is done.

 

Rhinophyma: Sebaceous cyst adenomatosis affecting the skin of nose. There are multiple sessile nodular elevations over the nasal tip. Treatment is aesthetic rhinoplasty.

 

Gummata: These are seen in the midline in the tertiary stage of Syphilis causing erosion of skin, mucous membrane and bone. Midline structures like palate, hyoid, nasal bone, forehead etc. can be involved. VDRL test clinches the diagnosis. It is getting more and more uncommon in this antibiotic age.

 

Sub mental Lymphadenitis: May be inflammatory or neoplastic and so the entire drainage area – the tip of tongue, floor of mouth, incisors, symphyseal alveolus should be examined for focus of infection or primary tumour. Other lymph nodes should also be examined to rule out a primary Lymphoma.

 

Ranula: Myxomatous or mucoid degeneration of sublingual salivary gland. It appears as a blue-grey domed cyst in the floor of mouth, which is brilliantly trans illuminant. It has a tendency to split the mylohyoid and project in the submental region- plunging ranula. Treatment is excision by oral approach or marsupilization.

 

Sublingual dermoid: Sizable swelling filling and distorting the sublingual space, this dermoid is located within the mylohyoid muscle or the intrinsic muscles of tongue. Treatment is excision by sub mental approach.

 

Ludwig’s Angina: This is a form of cellullitis, which starts in the submandibular region and spreads to the floor of mouth. It produces a diffuse swelling beneath the jaw as well as the floor of mouth, often fixing the tongue. The unyielding deep fascia of the neck pushes the oedema up towards the glottis and down towards the mediastinum. Fatal septicemia, airway obstruction and death may result. Treatment is emergency drainage and broad spectrum anti bacterial coverage for Gram +ve, Gram –ve and anaerobes.

 

Thyroglossal cyst: These are cystic swellings mostly infrahyoid but may be suprahyoid as well and they move both with deglutition and tongue protrusion. The Thyroid develops from the foramen caecum and invaginates down as a tract called Thyroglossal tract to become the Thyroid isthmus. The cyst can occur anywhere along this tract. The cyst can become infected and form an abscess, which can be drained like any other abscess and result in the formation of a fistula. Thyroglossal fistula thus formed is never congenital, always acquired. These cysts are lined by squamous, cuboidal or columnar epithelium and may have lymphoid and thyroid tissue. They can turn malignant. Treatment of cyst and fistula is excision in toto along with the entire tract right up to the foramen caecum, taking the middle 1/3 of hyoid along with.

 

Subhyoid bursitis: Soft fluctuant swelling below the hyoid, it moves with deglutition and cannot be distinguished from Thyroglossal cyst easily.

 

Lymph node on crico thyroid membrane: A secondary deposit from a primary in the larynx, if present an endoscopic laryngeal examination and biopsy is a must. It also moves with deglutition.

 

Laryngocele: A soft, variable, unilateral or bilateral swelling, arising from the upper part of Thyroid cartilage, this is a herniation of the laryngeal mucosa through a gap in the thyrohyoid membrane. The swelling moves with deglutition and is usually seen in musicians playing wind instruments like flute and bagpipes Treatment is excision and repair.

 

Thyroid: This butterfly like endocrine gland straddles the trachea and its isthmus is situated over the 3^rd.and 4^th. tracheal rings. It moves up with deglutition and may have variable shape, size, consistency and tenderness. Lesions in Thyroid can be inflammatory, neoplastic, autoimmune and idiopathic. Lymph nodes on either sides of the neck and features of hypo and hyperthyroidism should always be examined.

 

Thus ended Prof. Sahi’s lecture on Midline Swellings of the Head & Neck. The diagram that he made on the board, every time pops up in my mind, whenever I see patients with midline head and neck swellings. This was once in a lifetime teaching, which has stayed life-long!