Thirteen operations

Quite apropos, don’t you think? I’m surprised I’ve never done this before. Gott in Himmel knows there must be at least thirteen interesting operations.

Yes, I realize it’s Wednesday, but as I’ve mentioned before . . . somewhere in the world, it’s Thursday. Consider this a preemptive strike. And yeeessss I know it’s Halloween, but I don’t have it in me this year. If you really, really need a Halloween post, here’s my Hellraiser compendium from 2005.

In any case, some of these operations are pretty damned scary.

1. Frenoplasty. Let’s discuss some common suffixes. When surgeons cut a hole into something, we call it an -otomy (tracheotomy). If it’s a more permanent opening, it’s an -ostomy (colostomy). Take something out, it’s an -ectomy, and if we change the appearance of something, it’s a -plasty.

Frenoplasty is an operation to change the frenulum. But what’s a frenulum? Turns out, you have lots of frenulums (frenuli?) The band of tissue in the center of the upper or lower lip (oral side) connecting it to the gums, that’s a frenulum. The foreskin’s connection to the penis is a frenulum, too, and so is “a small band or fold of mucous membrane forming the posterior margin of the vulva and connecting the posterior ends of the labia majora. Also called fourchette.” But the only frenulum I care about is the one beneath the tongue. In most folks, this one is nearly nonexistent, but in people with tongue-tie, the lingual frenulum is exceptionally short. Hence, tongue-tie.

What is a frenuloplasty? We take an anesthetized patient (local or general, depending on the age), snip the frenulum, and suture it in such a fashion that the tongue’s mobility is preserved. Why do we do it? In very young infants, bad ankyloglossia (tongue-tie) can impair feeding. Older infants might have speech difficulties. Children might want to be able to stick their tongues out at their parents or teachers. And teenagers and adults might want better tongue mobility for, oh, I dunno. Blowing raspberries?

2. Trephination. It’s a band! No, it’s a website! No, it’s a hole in the head!

No, really. It’s a hole in the head.

Trepanation, or trephination (both derived from the Greek word trypanon, meaning “to bore”) is perhaps the oldest form of neurosurgery. The procedure, which is called a craniotomy in medical terminology, involves the removal of a piece of bone from the skull. It has been performed since prehistoric times: the oldest trepanned skull, found at a neolithic burial site of Ensisheim in France, is more than 7,000 years old, and trepanation was practised by the Ancient Egyptians, Chinese, Indians, Romans, Greeks and the early Mesoamerican civilizations. The procedure is still performed today, for both medical and non-medical reasons.

There used to be a personal account of self-trephination posted on the web, but I can’t find it. The guy did it to achieve a higher state of consciousness. This guy, however, did it by accident.

3. Circumcision. Eh. Been there, done that.

4. My favorite operation in the whole world, the bicoronal scalp flap. Why is it my favorite? Because it can freak out even the most seasoned scrub or circulating nurse. Once you see one or two of these, it’s old hat. But the first one is dramatic.

Trouble is, horror movies have numbed most people to such sights. Still, it’s one thing to see it in the funny pictures, quite another to watch your surgeon really do it.

Here are some pictures for you who are strong of mettle. This flap is done to provide access to the frontal (forehead) bone — I use it whenever I have to do a frontal sinus obliteration (for various reasons, if the frontal sinus is crushed, it’s best to get rid of it entirely rather than try to “fix” it). Simple thing, really. Cut across the scalp behind the hairline, going from ear to ear. There’s a loose layer beneath the scalp and above the cranium which can be finger-dissected. Sweep your finger around, then peel the forehead skin forward. And now you have access to the frontal bone!

5. Hemicorpectomy. To this day, I wonder who finds my blog using “hemicorpectomy” as a search term. (By the way — don’t google it. Just don’t. The operation is just what it sounds like, and that’s all you need to know.) Are these amputee fetishists who want to see pictures of the ultimate amputation stump? I surely hope not. On the other hand, are these individuals whose doctors have recommended the operation, or family members, or friends of such patients? That’s not much better. When I think of all the horrors surgeons inflict on their patients, this one ranks right up at the top.

6. Rhytidectomy is the proper term for a face lift. Yes, -plasty would be more accurate, since you’re not really excising rhytids (wrinkles). But we go into the O.R. with the terminology we have, not the terminology we would like to have.

Rhytidectomy relies upon the fact that certain areas scar well: the hairline and the skin immediately in front of the ears. You can make a nice, long incision here, elevate most of the facial skin, pull back, et voila!

Not bad. Note the decent job the surgeon did on her neck. Could have done better on her lids, but that’s another operation (blepharoplasty).

But I bet you want to know more about the incision:

With skin like that, why is she getting a face lift?

7. Hemorrhoidectomy. Based on the photo below,

hemorrhoids in the Modern Era are treated using a Chinese rocket. This, by all accounts, is more humane than the 19th Century treatment of hemorrhoids.

If I’m not mistaken, in plate VII, that’s a plume of smoke rising from the buttocks.

8. Rectal foreign body extraction.

Why suffer the embarrassment of an emergency room visit when you can take care of this problem at home? (Kidding! You have to go to the emergency room. ER docs and general surgeons live for this kind of thing.)

What I object to most on that page is the concluding statement, “Consider recommending sexual or psychological counselling.” That is just ignorant. Counseling only has one L.

9. Reduction mammoplasty, AKA breast reduction, is a godsend for the women who need it. (The procedure is probably done more often for back pain than for cosmesis.) For the first-time observer, however, it’s a lot like a bicoronal flap — frightening to behold. I saw my first reduction mammoplasty in medical school. Halfway through the operation, I couldn’t see how this could end in anything other than cosmetic disaster.

Here’s a typical set of before-and-after photos (NSFW, naturally). You’re looking at the scar which results from the keyhole incision, which is necessary to translocate the nipple upwards. Like all scars, I imagine these fade with time.

10. Extracorporeal shockwave lithotripsy (ESWL). Now, this is cool:

You lie on a water-filled cushion, and the surgeon uses X-rays or ultrasound tests to precisely locate the stone. High-energy sound waves pass through your body without injuring it and break the stone into small pieces. These small pieces move through the urinary tract and out of the body more easily than a large stone.

People get stones in their salivary glands, too, and surgical extraction can be painful. Wouldn’t it be nice if ESWL worked for salivary gland stones?

They’re doing it in Europe, but here in the States, it’s still considered experimental. Grrr.

11. Implants are not just for breasts anymore. Gluteal implants, cheeks, chins, calves, you name it.

If you’re The Enigma, you can have horns. And you can even get your penis beaded, for her pleasure (NSFW!!!!! and the Body Modification Wiki, OMG, sooo NSFW, too!!!!!)

12. Gastric bypass. To think, this used to be a rarity. Nowadays, I see at least two or three new patients a month who have had bypass.

Here’s a description of the various procedures. They all involve the creation of a malabsorptive state — in other words, the patient can no longer absorb most of their food. Post-op dietary modification is essential. The procedure costs $17K – $22K, and not all insurance plans cover it. Oh, and there’s an 0.5% mortality rate, too.

13. Face transplant is the new transplant kid on the block. Aside from a dippy Travolta movie (and if you can follow this plot, I bow to your superior intellect), this operation has been used to reconstruct a French woman mauled by her pet Labrador, a Chinese man attacked by a bear, and a Chinese rabbit ravaged by biomedical researchers.

Of course, where science treads, photoshoppers soon follow.

I hope you all had a safe, non-fattening Halloween, everyone. Are you ready for some linky lurve?

Dan remembered to do pumpkins this year, unlike yours truly.

rajav’s vocabulary list: thirteen words

From Kate: thirteen things about Shirley Jump

I hope there are no stairs in Carrie’s house . . .

Someone tell Shaina her breasts are FINE.

Congratulations are in order at Chez Nichtzusagen

Meanwhile, the sxKitten pulled out all the stops for Halloween

Deb, forget the tan. Get a massage.

protected static may be all wet

D.