April 2008


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ANATOMY AND FUNCTION OF THE HEART

The heart is a muscular organ a little larger than your fist weighing between 7 and 15 ounces (200 to 425 grams). It is responsible for pumping blood through the blood vessels by repeated, rhythmic contractions. The average heart beats 100,000 times per day pumping about 2,000 gallons (7,571 liters) of blood. The average human heart beating at 72 BPM (beats per minute), will beat approximately 2.5 billion times during a lifetime of 66 years.

The heart is usually situated in the middle of the thorax with the largest part of the heart slightly offset to the left underneath the breastbone or sternum and is surrounded by the lungs. The sac enclosing the heart is known as the pericardium.

anatomy of the human heart

The heart consists of the following parts:
Aorta: It is the largest artery and carries oxygenated blood from the heart to the rest of the body.
Superior Vena Cava: Deoxygenated blood from the upper parts of the body returns to the heart through the superior vena cava.
Inferior Vena Cava: Deoxygenated blood from the lower parts of the body returns to the heart through the inferior vena cava.
Pulmonary Veins: They carry oxygenated blood from the lungs back to the heart.
Pulmonary Arteries: They carry blood from the heart to the lungs to pick up oxygen.
Right Atrium: It collects deoxygenated blood returning from the body (through the vena cavas) and then forces it into the right ventricle through the tricuspid valve.
Right Ventricle: It collects deoxygenated blood from the right atrium and then forces it into the lungs through the pulmonary valve.
Left Atrium: It collects oxygenated blood returning from the lungs and then forces it into the left ventricle through the mitral valve.
Left Ventricle: It is the largest and the strongest chamber in the heart. It pushes blood through the aortic valve and into the body.

HOW DOES THE HEART FUNCTION?

The right side of the heart collects de-oxygenated blood from the body into the right atrium and then via the right ventricle pumps it into the lungs so that carbon dioxide can be dropped off and oxygen picked up.

The left side of the heart collects oxygenated blood from the lungs into the left atrium. From the left atrium the blood moves to the left ventricle which pumps it out to supply oxygen to the body.

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ORTHOGNATHIC SURGERY

Orthognathic surgery is surgery to reposition the maxilla (upper jaw or jawbone), the mandible (the lower jaw or jawbone), and the dentoalveolar segments (teeth and their sockets) to achieve facial and occlusal balance. One or more segments of the jaw(s) can be simultaneously repositioned to treat various types of malocclusions (bad bite) and jaw deformities. It is also used in treatment of congenital conditions like cleft palate. Bones can be cut and re-aligned, held in place with either screws or plates and screws.

Relationship between the maxilla and mandible

Orthognathic surgery is performed by an oral and maxillofacial surgeon almost always in collaboration with orthodontic treatment, often including braces before and after surgery, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies.

Unless medical conditions necessitate that the surgery be performed earlier, orthognathic surgery is often delayed until after all of the permanent teeth have erupted. To improve the aesthetic results, orthognathic surgery can be combined with soft tissue contouring in adult patients.

TYPES OF ORTHOGNATHIC PROCEDURES
•  Mandibular Sagittal Split Osteotomy
•  Maxillary osteotomy surgery or Le Fort Osteotomy (Le Fort I osteotomy, Le Fort II osteotomy and Le Fort III ostetomy)
•  Genioplasty (chin surgery)

DETAILS OF THE PROCEDURE
Usually surgery is performed under general anaesthetic and using nasal tube for intubation. The surgery might involve one jaw or both the jaws during the same procedure. The modification is done by making cuts in the bones of the mandible and / or maxilla and repositioning the cut pieces in the desired alignment. The surgeon is often able to go through the inside of the mouth without having to cut the skin.

Cutting the bone is called osteotomy and in case of performing the surgery on the two jaws at the same time it is called a bi-maxillary osteotomy (two jaws bone cutting) or a maxillomandibular advancement. The bone cutting is traditionally done using special electrical saws and burs, and manual chisels, and most recently by using ultra-sound waves (though not used on a wide scale). The maxilla can be adjusted using a ” Lefort I” level osteotomy. Sometimes the midface can be mobilised as well by using a Lefort II, or Lefort III osteotomy. These techniques are utilized extensively for children suffering from certain craniofacial abnormalities such as Crouzon syndrome.

The jaws will be wired together (inter-maxillary fixation) using stainless steel wires during the surgery to insure the correct re-positioning of the bones. This in most cases is released before the patient wakes up after the surgery.

COST OF ORTHOGNATHIC SURGERY
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SEPTOPLASTY

The surgical procedure to treat problems associated with a crooked or deviated nose, such as chronic sinusitis, inflammation, bleeding, or sleep apnea, is termed septoplasty.

Septoplasty, submucous resection of the septum, or septal reconstruction is a corrective surgery to straighten or repair a deviated nasal septum – the wall between the two nasal passages. Usually the septum is straight and upright, and runs down the center of the nose. A deviated septum occurs when the cartilage or bone of the septum is not straight, thereby narrowing the cavity into which is deviates making breathing difficult. This condition can lead to snoring and sleep apnea, and in certain serious deviations may frequently lead to chronic sinus problems.

Septoplasty is necessary only when the problems associated with crooked nasal septum do not get better without surgery. The surgery may be done along with other procedures to treat chronic sinusitis, inflammation, or bleeding, or to correct sleep apnea. The procedure also may be done to allow access into the nose to remove nasal polyps.

DETAILS OF THE PROCEDURE
The procedure usually involves an excision or cutting of a portion of the cartilage and/or bone surplus. Under general or local anesthesia, the surgeon works through the nostrils, making an incision in the lining of the septum to reach the cartilage targeted in the operation. Often an “L” strut of cartilage in the dorsal and caudal areas (1cm width or more) is preserved for structural support. After excess cartilage and bone have been taken out, the septum may then be stabilized with small plastic tubes, splints, or sutures. The operation takes about 60-90 minutes.

AFTER THE SURGERY
Considerable swelling and bruising can be expected. The nasal cavities may or may not be packed, and a piece of gauze is taped underneath the nose to absorb blood. Postoperative care includes frequent changing of this gauze (roughly every hour or so) and after 1 to 2 days, the excess bleeding normally stops and the inner nasal packing may be removed. The following day, saline irrigations of the nasal cavities are often advised, and the patient may be allowed to gently blow their nose. After 1 to 2 weeks, patients are allowed to blow their nose normally. Patients typically regain about 80% of their energy one week after the surgery.

COST OF SEPTOPLASTY
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