A fractured nose is the most common facial fracture. It usually results from blunt injury and is commonly associated with other facial fractures. The severity of the fracture depends on the direction, force, and type of the blow. A severe comminuted fracture may cause extreme swelling or bleeding that may jeopardize the airwayand require a tracheotomy during early treatment.


Fractures of the nasal bones usually result from direct trauma. The causative injury can be relatively minor such as a fall, or more severe such as a motor vehicleaccident.


Nasal fractures can cause septal deviation and bone displacement, resulting in an airway obstruction. These complications can be permanent if treatment is inadequate or delayed. The patient may also develop septal hematoma, leading to abscess formation and avascular and septic necrosis. Other possible complications include cerebrospinal fluid (CSF) leakage and intracranial air penetration, which may lead to meningitis.

Assessment findings

The patient’s history reveals a direct blow to the nose. He usually reports the immediate onset of pain, a nosebleed (ranging from minimal trickling to hemorrhage),and soft-tissue swelling. If his nasal passages are obstructed, he may breathe noisily.If you perform inspection soon after the injury, you may note a swollen nose with bleeding and deformity or displacement of the nose from the midline. A fracture maynot be obvious, however, because swelling can obscure the break.Inspection performed several hours after the injury may reveal periorbital ecchymoses (raccoon’s eyes), nasal displacement, and deformity.You may be able to identify the fracture on palpation.

Diagnostic tests

X-rays help to confirm the diagnosis and determine the extent of injury.


The patient may not need treatment unless he has suffered bone displacement, septal deviation, or a cosmetic deformity.When necessary, prompt treatment restores normal facial appearance and reestablishes bilateral nasal passages after swelling subsides. Reduction of the fracture(restoring the displaced bone fragments to their normal positions) corrects alignment; immobilization (intranasal packing and an external splint shaped to the nose andtaped) maintains it. Nasal fractures should be reduced within the first 24 hours if possible, using local anesthesia for an adult and general anesthesia for a child. Severe swelling may delay treatment for several days to per week, making reduction more difficult. In this case, the patient may need general anesthesia.If CSF leakage occurs, the patient needs close observation and antibiotic therapy. Septal hematoma requires incision and drainage to prevent necrosis.




Dr. Altaf H Malik

Dept. of Oral and Maxillofacial Surgery,

Govt. Dental College, Srinagar.

Co authors: 

Dr. Ajaz A Shah

Associate Professor and Head,

Dept. of Oral and Maxillofacial Surgery,

Govt. Dental College, Srinagar.

Dr. Suhail Latoo


Department of Oral Pathology and Microbiology,

Govt. Dental College, Srinagar.

Dr. Manzoor Ahmad Malik

J & K Health Services, SDH Banipora

Dr. Rubeena Tabasum


C.D Hospital, Srinagar.

Dr. Shazia Qadir

Dept. of Oral and Maxillofacial Surgery,

Govt. Dental College, Srinagar.


Incisions in head and neck region are having particular importance because of presence of a large number of vital anatomic structures and also because of aesthetic reasons. Any damage to the structures such as nerves in this region should be avoided by careful planning of the incision. The scar resulting from incisions in this region are well exposed and is not normally hidden by usual clothing. A proper planning and technique of incision and closure is the only choice to avoid such scars.


   In general an incision should be

  • Close to the area to be approached
  • Should not involve or damage any vital anatomic structures(e.g. nerves and arteries)
  • Should give excellent visual and mechanical access.
  • The cosmetic deficit should be as minimum as possible
  • Incision should not alter the contour  of any structure.
  • It should not prevent vascularity or lymphatic drainage.
  • Should be placed in areas where healing is easy

   For better aesthetic results the following basic concepts are used.

  1. The incision may be hidden inside an orifice e.g. oral cavity, nasal cavity.
  2. Hair bearing areas and hair lines provide coverage.
  3. The   junction of aesthetic units are useful e. g. vermilion border, around ala of nose.
  4. Incisions are put in normal wrinkles, skin creases etc.


Incisions hidden inside orifices leave no scar and is cosmetically superb, examples are the degloving incisions used in oral cavity to expose the mandible or maxilla, rhinoplasty or septoplasty incisions placed inside nose, orbital rim and floor may be approached through conjunctival incisions.

Disadvantages are

  • Post-operative alteration in the appearance of orifices e.g. altering the symmetry of nose, loss of buccal and labial sulcus depth, exposure of sclera etc.
  • Limited movements of conjunctiva and lips due to scarring .
  • Break up of incision lines due to movement
  • Compromised asepsis
  • Compromised access
  • Need for special instruments


Hair bearing areas and hair lines give excellent coverage of scar giving a superior cosmetic result .It is the principle behind the use of eyebrow, bicoronal and hair line incisions.

When putting an incision in the hair bearing area

  1. Incision should be placed parallel to hair follicle i.e. perpendicular to skin in scalp incisions, a bevelled incision in eyebrow.
  2. Incision should not be placed in an hair where future balding is anticipated.


Junction of aesthetic units are excellent areas where scar can be concealed. This include the labio buccal groove, nasal cheek junction, lower lip cheek junction, ear face sulcus. These areas are used in Weber Fergusson incision, lateral rhinoplasty incision, nasolabial flaps, parotid and face lift incisions.


Normal wrinkles and skin creases are another option to put incision if it is not possible to use the above mentioned areas. These wrinkles are areas where skin normally gets folded if there is no tension. These correspond to the attachment of muscle fibres or direction of collagen bundles within the dermis and subcutaneous tissues. Several such lines are described

Langer (1861) found that puncture wounds made in fresh cadavers assume a slit or oval configuration as rigor mortis progressed. The wound’s long axis found to correspond to greatest static tension of skin. Based on this Langer described some lines known as Langer’s lines and he recommended that the long axis of incision should be corresponding to these lines in order to reduce the extent of scarring.

Lines of minimum tension is another line described for this purpose. These are also known as favourable skin tension line, natural skin crease or wrinkles. Examples are forehead wrinkles, glabellar frown lines etc. they are caused by repeated bending of skin by the action of underlying musculature exerted on the skin itself or on other movable structures in head and neck. Attachment of frontalis muscle causes forehead wrinkles, corrugator supercilliary muscles causes wrinkles at glabella and the wrinkles at temporal region known as crow’s feet are caused by repeated animation of orbicularis oculi muscle.

Relaxed skin tension lines are most accepted lines for incision nowadays. These are lines that follows the furrows when skin is relaxed. Unlike normal creases these are not visible features normally, but can be formed by pinching the skin and observing the furrows and ridges that are formed. These lines correspond to the directional pull that exist in relaxed skin. The pull is determined largely by protrusion of the underlying bone, cartilage and tissue bulk that the skin covers. The relaxed skin tension line exerts a constant tension on the face when it is repose even during sleep and are altered only temporarily by muscle contraction. It is for this reason that the incisions that incisions made along the tension lines heal better than those made tangentially to tension lines.

Langer’s lines, lines of minimum tension and relaxed skin tension lines will not correspond in many region.

Borge’s(1984) study concluded that use of Langer’s lines resulted in wider scars. Relaxed skin tension line give better result than any other lines.

If natural skin crease is prominent in one site it should be used instead of relaxed skin tension line. In areas where incision have to be put perpendicular to relaxed skin tension line a running W plasty should be done.

Incisions in growing children heal with a broad scar. It is because the scar is getting stretched as the child grows.


In general the incisions should be planned well before it is made and is marked with a skin pencil or bonneys blue. The skin is stretched before putting incision. The flat side of no 15 blade is used to put skin incision. If the tip is used to put skin incision, it is difficult to control the depth. A table knife grasp is used for skin incision and a pen grasp for mucosal incision.

Langer’s incision should be cross hatched at 2 to 3 areas in order to get good approximation of wound edge at end of the procedure.

The area of the incision can be infiltrated with 1 in 1,00,000 solution of adrenaline to get vasoconstriction, to reduce oozing of blood.

Skin and subcutaneous tissue should be penetrated in one sweep if possible.

Like that in mucoperiosteal flap mucosa and periosteum should be cut in a single sweep. Always use pulling movements.

If a multi-layered exposure is to be done, each layer is incised separately and dissected out. This will facilitate layer by layer closure. The edges of the flap should not be grasped with tissue forceps, dissecting forceps or towel clip, since they will be crushed and damaged.

The skin is elastic, extensible and resilient. These characteristics vary from birth to old age.


            Skin possesses a degree of elasticity owing to presence of elastic fibres in the dermis. The elasticity maintains the skin in a constant tension. This is demonstrated by the gaping of wounds following incision through the dermis and also by immediate contraction of skin grafts as they are removed from the donor site. Thicker the skin graft greater the amount of elastic tissues and associated contraction. The elasticity and extensibility of the skin also facilitates the shifting of skin flaps.

            The lines of skin tension in the skin was first noted by Dupuytren (1832).

            Langer (1861) considered that human skin was less extensible in direction of lines of tension than across them.

            Practical experience has shown that wounds heal better and scars are less conspicuous when incisions are made within or parallel to natural flexion lines, lines of facial expression.

            Gibson (1967) has shown that when skin is stretched, collagen and elastic fibres become aligned in the direction of the stretch. This condition exists in the lines of expression or creases of flexion. Wounds within or parallel to these lines are less subject to tension from activity of the underlying musculature that has produced the lines of tension.


            In a cutaneous defect maximal contraction results in a scar (contracture) whose long axis crosses the lines of minimal tension at right angles. The lines of minimal tension are the result of adaptation to function the skin being constantly pulled and stretched by the underlying muscle and joint. The connective tissue collagen and elastic fibres are arranged in bundles that are perpendicular to the underlying muscles.

            A scar parallel to the line is not subject to the intermittent pull of the subjacent muscles, hence the term ‘lines of minimum tension’. An incision placed within a line of minimum tension or parallel to it is submitted to minimal tension during healing. Borges (1973) preferred the term relaxed skin tension lines in describing these lines.

            In the head and neck lines of minimum tension represent adaptation to two different types of functional mechanisms. The first type is represented by the lines of habitual expression in the face such as the lines in the forehead, eyelids and nasolabial folds and other lines of expression around the mouth. The second type, lines of skin relaxation such as horizontal circular lines in the neck that result from movements of flexion and extension.

            An incision perpendicular to line of minimum tension is subjected to constant changes in tension as a result of activity of underlying musculature, hypertrophy of scar often develops. Only slightly visible scar results when incisions in the neck are made within a skin fold or crease or parallel to the fold.


            This is produced by repeated and habitual contracture of the underlying muscles of facial expression. In some regions, a number of muscles act in unison. The nasolabial fold is the area between the skin of the lip that is tightly bound to orbicularis oris and the loosely bound skin of the cheek over the buccal pad of fat. The nasolabial fold is also formed by muscular contraction of zygomaticus, levator labii superioris and caninus muscle, and in part by risorius and buccinator.

 The supraorbital wrinkle lines are formed by frontalis muscle which is inserted into the skin of lower forehead.

The vertical lines in the lower part of nose are due to contraction of transverse portion of nasalis muscle. The crease lines develop radially from oral fissures. At angles of mouth, however, the combined action of quadratus labii superiorus and other muscles in this region causes the lines to blend with nasolabial fold.

The formation of lines on the lateral aspect of the chin results from the action of triangularis, quadratus labii inferiorus and mentalis muscle.

The transverse lines across the neck, located perpendicular to platysma muscle separate folds of excess skin thus permitting extension of neck.

Every individual possess the line of expression that becomes more apparent when the muscles contract. Wrinkles are less evident in young persons. However in old age, skin crease and wrinkles are more numerous because the skin through degenerative changes has lost its elasticity and become redundant. Because the skin is less elastic and also redundant in old age, it is incapable of assuming its smooth appearance at the termination of muscle contraction.


            The size and direction of an elective incision should always be chosen in relation  to lines of minimal tension. Although lines of expression and flexion coincide with line of minimum tension and are the best guide to the placing of incisions. There are exceptions e.g.- submental fold.


Bicoronal incision

            It is an ideal incision for approach to upper one-third of facial skeleton and the anterior cranium. This extends from one temporal region to the other and involves a major part of the scalp. For putting this, it is recommended to shave the hair for only a strip of 3-4 cms where the incision is to be made. The incision begins at the upper attachment of the helix on one side and extended transversely over the skull to the opposite side. This can be curved slightly forwards at the skull following but posterior to the hairline. The incision is often extended preauricularly to provide access to the zygomatic arches.

Initially, the incision is made deeply to sub-aponeurotic areolar tissue and the flap is raised along this plane, leaving the periosteum intact. Rarely clips are applied to the edges of the flap to aid in hemostasis. The periosteum is incised about 3 cm above the supraorbital rim and then the dissection is proceeded subperiosteally. This can be proceeded until the nasoethmoid, nasofrontal and frontozygomatic region are exposed. The supraorbital neurovascular bundle is made free from the foramen by cutting them at the lower edge of the foramen.

            The lateral and temporal dissection follows the outer surface of temporal fascia up-to approximately 2 cm above the zygomatic arch. At the point where the temporal fascia splits into two layers, an incision running at 45? upward and forward is made through the superficial layer of temporal fascia. This incision is connected anteriorly with the lateral or posterior limb of supraorbital periosteal incision . Because the frontal branch of facial nerve courses obliquely 1.5 cms lateral to the eyebrow and not more than 2 cms above the brow, the connection between the fascia and the periosteal incisions should be at least 2 cms lateral and 3 cms above the eyebrow. The posterior extension of the temporal incision of the fascia is extended to cartilaginous auditory canal.

            Once a plane of dissection is established deep to the superficial layer of temporal fascia, the dissection is continued inferiorly until the periosteum of the zygomatic arch is reached. The periosteum is incised and the zygoma, frontal bone, superior and lateral orbital margins, nasal bone and part of parietal and temporal bone are exposed.

When hemicoronal incision is planned, this incision will be stopped just short of midline.


            Maximum exposure of upper one-third of facial skeleton and fronto-parietal region of cranium is exposed by this incision. This helps in management of

a)      extensive craniofacial trauma

b)      correction of craniofacial deformities

c)      single incision allows management of facial trauma and concomitant craniotomy if indicated

d)     good cosmetic result

e)      avoids injury to facial structures

f)       allows harvest and placement of cranial bone grafts

The method of wide exposure of facial skeleton using bicoronal incision has been confirmed in the literature by various authors(Launtzen et al 1986, Jackson 1989, Wedgewood et al 1992)


a)      loss of hair due to injury to hair follicle in the incision line

b)      poor scar in case of male type baldness

c)      inadequate access to middle third of facial skeleton

d)     excessive haemorrhage

e)      potential for damage of temporal branch of facial nerve resulting in weakness of frontalis muscle

f)       post-operative hematoma due to wide dissection of scalp

g)      sensory disturbance, anaesthesia or paresthesia affecting supraorbital and preauricular regions

h)      trismus, ptosis and epiphora are also reported.

Various methods for hemostasis of bicoronal incisions are

a)      use of surgical clips

b)      cautery

c)      injection of lidocaine with epinephrine


       Authors John D Burgoyne and Monte S said that the surgical clips have a distressing tendency to fall off. Cautery can cause tissue necrosis and poor wound healing. They recommended a technique in which after making the incision and before making the incision, placing two rows of running locked sutured through the scalp to the level of galea, one on each side of the incision approximately 3 cm apart using 3-0 nylon suture. Authors feel that bleeding can be controlled by this method.

Incisions to approach orbitozygomatic complex fractures and nasoethmoid fractures.


Skin of periorbital region is thin and having little subcutaneous tissue. This produces prominent skin creases over this region. Skin lies directly over highly vascular orbicularis oculi muscle this provides good blood supply to the skin. The skin in this region is tension free. The number and position of skin creases vary depending on tone of orbicularis oculi muscle. Main creases are upper and lower skin creases. The superior one generally follow the contour of upper lid running 8 to 10 mm above the cilliary margin where levator aponeurosis insert into the pretarsal layer of orbicularis oculi.

The lower crease runs more obliquely from lid margin 3 to 7 mm and is formed by the attachment of extension of inferior oblique muscle. The action of orbicularis oculi produces a large number of relaxed skin tension lines in this region.

Recent recommendations support more centrally placed incisions. More peripheral orbital incisions increase risk of damage to peripheral branches of fifth cranial nerve including supraorbital, supratrochlear, infraorbital, infratrochlear nerves and also the temporal and zygomatic divisions of facial nerve.

Incisions of upper lid can cause postoperative ptosis if the attachment of levator palpebrae superioris is transected.

Another important thing is lymphatic drainage. Orbit does not have any lymph node. Lymphatics from this region drains to preauricular, intraparotid nodes mainly and also to submental and submandibular nodes. Mainly these lymphatics run in a lateral direction. Transection of these due to laceration or incision will produce intractable lymphedema especially in adults.


            This incision was first described by Converse and Smith (1962)

            Excellent exposure of nasal bridge and canthal ligaments are achieved by this approach.

Bilateral Z incision

            This was described by Digman et al (1969).

Midline vertical approach

            This was described by Strang (1970). Here a 2 to 3 vertical incision is made from forehead to the base of the nose. The soft tissues are undermined to reveal  the medial canthal ligament.

            Visibility is found to be excellent with this approach.

W shaped approach

            A curved transverse incision is made across the base of the nose within a skin crease and extended on both sides upwards and laterally just below the eyebrows.

            By careful blunt dissection supraorbital nerves are identified and preserved.

            This approach provides excellent visibility and access for repositioning and direct plating of the various bone fragments.

            This approach like H shaped approach inevitably leaves a scar across the bridge of the nose.

Bicoronal incision

            Bicoronal incision gives an excellent exposure for repair of fractures of nasoethmoid complex.

            Frontal bone is exposed almost entirely with the upper part of the nose and access is provided to the roof, medial and lateral walls of the orbits including the zygomatic arches.


            This incision should not be at right angle to the skin surface, but instead at the same angle as emerging hair to avoid transection of follicle that would impair growth. Hairs need not be shaved since they provide a valuable guide for alignment during skin closure. An incision of 1.5 cm in length is adequate.

            Blunt dissection is carried out through underlying muscle fibres and the periosteum is then incised and stripped away from the outer and inner aspects of zygomatic process of frontal bone and frontal process of zygomatic bone for a distance of 0.75 cm from the bony margins. There is good exposure of frontozygomatic suture.

            The incision can be extended medially to give exposure of supraorbital rim, frontonasal junction.

Superolateral incision

            This was described by Wright (1979).

            This incision is along the orbital rim beneath the lateral eyebrow continued down to the level of lateral canthus and extended laterally on to the zygoma if necessary. It exposes the lacrimal fossa, the lateral half of superior orbit and the frontal extension of the zygoma. The curved or S shaped incision allows extensive stretching so that wide exposure can be achieved. This is used for fracture reduction, lateral orbitotomy etc.


            This leaves a prominent scar below the eyebrow.

  Lateral canthotomy

            This was described by Berke (1954).

            This is put in skin crease and extended several millimetres from the lateral canthus. It is commonly associated with other incisions to improve access. It gives access to frontozygomatic sutures and lateral orbital rim.


            It has got poor access to the infraorbital margins and there is chance for injury to the branches of facial nerve due to lateral extension of the incision.


Medial crease incision

This was described by Katowitz (1981).

            It is a modification of upper lid crease incision in which only the medial aspect of upper crease is utilised. This gives good access to medial orbital wall.

Gillies temporal incision for elevation of orbitozygomatic complex fractures

            It is placed in the temporal region between the anterior and posterior diversions of superficial temporal artery.

            Incision is of 2 cm length and directed upwards and anteriorly at an angle of 45°. It is carried through the skin, temporal fascia and the temporalis muscle is exposed. The elevator is passed underneath the zygoma. This leaves no scar.

Upper lid (Blepharoplasty) incision.

            This is through the upper lid crease about 8 to 10 mm above the margin of upper lid. The skin is raised from the surface of tarsal cartilage and dissection proceeded below orbicularis oculi to reach superior orbital rim.


–          Superior aesthetic result.

–          No risk of damage to surrounding nerves.

–          No risk of postoperative ptosis.

–          Less damage to orbicularis oculi.


–          Technical difficulty.

–          Difficult to separate skin from the muscle layer.

–          Chance of necrosis of thin skin flap.

–          Severe post operative oedema.


Incisions to approach infraorbital rim and orbital floor.

            Access to the inferior orbital margin, which can be extended, if required to the orbital floor may be gained by the following approaches.

1)                  Transconjunctival

2)                  Infra orbital

  • Sub-ciliary
  • Sub-palpebral

3)                  Supratarsal fold incision

A guiding principle for surgical approach to the orbital floor is the use of a stepped incision where each layer of tissue is divided at a different layer so as to provide a more extensive area for subsequent healing.  An incision of all layers at the same level should be avoided to prevent a depressed scar.  The tissue must be handled with delicate instrument.

The transconjunctival approach Advantages

  1. Invisible scar


  1. Restricted access
  2. Greater degree of operative dexterity required if complications are to be avoided.

                        Originally developed by Bourguet (1928) as a cosmetic procedure for the treatment of fat herniation in the lower eyelids this approach was developed by converse et al (1973) and Tessier (1973) for the treatment of fracture and by the latter author for the surgical correction of  congenital malformations.  The technique was compared with the sub-ciliary incision by Wray et al (1977) and also reviewed by Borstlap and Freihofer for the insertion of transosseus wires following fractures of inferior orbital margin.

Ilankovan (1991) describe d the existence of a periorbital envelope which separates the orbital floor and a potential post septal space as important anatomical land marks when approaching the infraorbital rim and orbital floor through this approach.

Operative technique:

            Traction sutures are inserted into the margin of the lower eyelid and the inferior conjunctival fornix is secured with a fixation suture to facilitate elevation and undermining this layer.  This preliminary part of the operation is also assisted by the injection of saline and adrenaline solution, the needle being inserted initially between the conjunctiva and the tarsal plate and subsequently inserted again through the skin deep to the palpebral portion of the orbicularis oculi, but superficial to the orbital septum which is then isolated by fluid on both superficial and deep aspects.  After stabilising the lower eyelid with traction sutures and elevating the conjunctiva with the fixation suture, a small incision is made 3mm below the tarsal plate on the medial aspect and in line with the punctum.  This allows the introduction of the points of fine scissors so that the conjunctiva and orbital septum which are closely adherent at this point may be undermined and dissected free from the orbicularis oculi and orbital septum are divided by the scissors as far as the line of lateral canthus and a retractor such as Desmarres pattern, inserted into the wound. 


            The level of division is critical since if placed too low down near the fornix it will be below the fascia passing from the inferior rectus to the tarsal plate and thus allow the escape of periorbital fat.  If placed too high there may be distortion of the lower eyelid.

            The tissue are then separated on a plane superficial tot the orbital septum but deep to the orbicularis oculi muscle, using blunt dissection and small gauze swabs, until the orbital rim is reached.  It is important to continue the dissection for about 5mm below the rim before incising the periosteum on the anterior aspect.  If the periosteum is incised directly over the rim the periorbital fat will herniate through and interfere with the operation and be extremely difficult to replace when the tissues are closed.  The periosteum must be clearly defined across the entire width of the orbital margin and the infraorbital nerve dissected free from any fibrous or muscular attachments.

            The periosteum is now divided just above the infraorbital foramen and elevated from the lateral to medial aspect, until the rim is exposed.  Retraction is maintained by means of a malleable copper strip.  Further elevation of the periosteum of the orbital floor proceeds from the medial to lateral aspect using a combination of sharp dissection with a periosteal elevator in those areas away from the infraorbital groove and small gauze swabs about 1cm in size to push away the tissues where there are adhesions around nerves  and vessels or comminuted fragments of bone.  It is possible to dissect as far posteriorly as the anterior limit of the inferior orbital tissue but exposure beyond this point becomes progressively more difficult.

            The transconjunctival approach is useful for those procedures which do not require an extensive exposure of the orbit and can be limited to the inferior margin and the anterior aspect of the floor.  When there has been a major displacement of the floor or the exact extent of the injury cannot be accurately assessed before-hand a trans-cutaneous approach offers a greater degree of latitude and flexibility.  Closure is effected by insertion of a few catgut sutures to approximate the periosteum, taking care to ensure that the margins are accurately apposed to one another on the anterior aspect of the inferior rim.  A failure to secure this layer tissue would result in contracture and distortion of the orbital septum which in turn would lead to ectropion of the lower eyelid.  The conjunctival incision may be closed with 5-0 silk either as interrupted or continuous.

The infraorbital subciliary approach:

            The technique is sometimes described as blepharoplasty type of incision since it is similar to that employed for the excision of redundant skin below the lower eyelid.

            It provides an excellent exposure of the entire orbital floor and the lower part of lateral and medial walls.  If combined with other approaches from the outer or inner aspects of the eyebrow almost all areas can be reached with safety and without undue difficulty.

Approach is by

  1. Preliminary injection of local anaesthetic solution to separate tissue layers.
  1. Although the extension may not be required, it is better to delineate it accurately before the tissues became distorted by oedema.
  1. The dissection is continued to expose the full width of operative field.
  1. Incision of orbicularis oculi:
  2. Dissection then continues below this level until a point is reached about 0.5mm below the orbital margin.
  1. Incision of periosteum
  2. After identifying the infraorbital nerve and cleaning away any fibrous septa or muscular attachments the periosteum is incised down to the bone across the full width of the orbit.
  1. Elevation of periosteum and further dissection
  2. As in case of the subconjunctival approach the periosteum is elevated from the lateral aspect first and when stripping it away from the orbital rim it is better to start on the medial side.

10.  In the region of infraorbital neurovascular bundle, dissection with gauze swab will be useful.  As the dissection proceeds tissue must be held up with special retractors, with care taken by the assistant not to exert excessive pressure upon the undersurface of the globe.

11.  A slight elevation of periosteum from the medial and lateral aspect will enable posterior extension of dissection.  However when elevating the periosteum from the medial aspect care must be taken to avoid damage to the origin of inferior oblique muscle but the tendon can be dissected clear of periorbital tissues  to a considerable extent if required and this will further aid the elevation of the globe.

12.  Limit of dissection:

13.  Posteriorly upto the anterior limit of the inferior orbital tissue.

14.  Laterally above the level of insertion of lateral palpebral ligament.

15.  Medially the anterior two thirds of orbital plate of ethmoid bone.

16.  More anteriorly care must be taken not to disturb the lacrimal sac and structures attached to the margin of lacrimal fossa.

17.  The liberation of incarcerated tissue will be facilitated by the use of traction test in conjunction with any separation of adhesions and the operator can then be satisfied that all the mechanical obstruction to ocular movement has been eliminated.  Any loose fragments of bone around the margins of the defect are removed.

Advantage of subciliary incision are wide exposure and cosmetically acceptable scar.

Disadvantages include possible development of ectropion, entropion and  persistent oedema of lower eyelid (This results from dissection of orbicularis oculi muscle and injury to lymphatic vessels).

                        In a modification of the subciliary incision by Philips et al after the usual stepped type incision to expose the fracture site and after completion of the necessary management two or three holes are drilled in the inferior orbital and the free edges of the dissected periosteum and underlying muscle is elevated and sutured to the orbital rim.  Therefore the thicker skin, subcutaneous tissue are re-suspended in anatomical position.  This has been claimed to further reduce the chances of ectropion.

Infraorbital subpalpebral approach

                        Here infraorbital incision is made 5mm below the lower lid margin through a natural skin fold.  The subcutaneous dissection is extended to the lower eyelid and then deepened through the orbicularis oculi to the orbital rim.  The periosteum is incised and elevated from the orbital floor.  As mentioned earlier dissection is in layered manner to decrease scarring and fixation of soft tissue to bony orbital rim.


Supratarsal fold incision

            The incision is placed in skin fold parallel to superior palpebral sulcus above the tarsal plate( 10 to 14 mm above the anterior margin of upper lid). A 2 cm incision is usually adequate. It can be extruded medially or laterally into the crows fold skin crease. With a modest skin flap raised orbicularis oculi is separated by blunt dissection. Care is taken not to perforate the underlying orbital septum. The dissection continue superiorly and laterally to the periosteum of orbital rim. This is incised sharply to expose supraorbital rim and zygomaticofrontal suture. The dissection can be carried into the temporal fossa posterior to the frontal process of zygoma to provide access for elevation of the zygomatic complex.



INCISION FOR MAXILLECTOMY(Fergusson’s incision & its modification).

            The classical exposure of the maxilla used the Fregusson’s incision and this incision with its modification are still the incision being used for maxillectomy.

            This incision runs vertically through the centre of the upper lip from the red margin to the base of the columella. An equally good result can be obtained by following the philtral prominences. At the base of the columella, the incision turns horizontally running in the angle between the nose and the lip, the cheek around the alar base. Then the incision turns up along the side of the nose almost to the inner canthus. Before actually putting the incision, its line should be drawn with Bonney’s blue and matching points tattooed for subsequent suturing.

            From the inner canthal area the classical Fergusson’s incision runs laterally across the lower eyelid at a distance from the lid margin. The placing of the incision in this line is recognised to result in intractable lymphoedema of the eyelid. To avoid this a modified version is used which runs parallel to and 2 to 3 mm from the lid margin. The skin of the eyelid is elevated as a part of the cheek flap leaving the greater part of orbicularis, the tarsal plate and the conjunctiva in-situ.

            The upper lid is divided in full thickness and the incision is continued backwards along the upper buccal sulcus to the maxillary tuberosity. The cheek flap is then elevated off the underlying maxilla.

            Thus the Fergusson’s incision in its classic and modified form gives a wide exposure. If orbital extension operation is carried out along with maxillectomy the incision can be further extended to encircle the lid margins.


            Incisions to approach the parotid region are complicated by the presence of facial nerve. The main trunk itself or the cervical and marginal mandibular branches may be involved in the incision. Therefore the incision in this region should be placed in an area where

–          there is no risk of damage to the facial nerve.

–          Should give acceptable access to the superficial and deep lobe of parotid gland.

–          The scar resulting from this should be aesthetically acceptable.

In general all incisions for access to parotid should have 

–          A preauricular part that extend from variable distance from upper attachment of helix to the ear lobe.

–          A retroauricular portion following the posteroinferior portion of auricle.

–          A cervical extension that extends to a variable distance to the mastoid region

–          A submandibular part along the submandibular crease.

The facial nerve after emerging from stylomastoid foramen enters the gland through its posteromedial surface and comes anteriorly and laterally to divide in the plane of superficial and deep lobe of the gland. This level correspond to the infratragal notch of the auricle. So incision in this region should involve only skin and subcutaneous tissue.

For proper identification of the facial nerve it is appropriate have a blood less field for which either use of hypotensive anaesthesia is preferred or injection of epinephrine into the incision and operative site between the tragus and the posterior belly of digastric.

The original Blair incision began superiorly paralleling the last centimetre of the zygomatic arch then turned sharply inferiorly passed anterior to the ear and continued into the neck along the anterior border of the sternocledomastoid muscle.

In the Triple modified Blair incision the part paralleling the zygomatic arch has been eliminated. The incision begins superiorly immediately anterior to the helical rim passes between it and the tragus continues inferiorly on the posterior surface of the tragus curves anteriorly between the tragus  and  the lobule, curves posteriorly under the lobule to the mastoid process, then curves gently inferiorly to pass into neck in a natural wrinkle if one is present in an appropriate location. The flap is elevated sharply to the anterior border of the gland to expose the operative field.

The structures that surround the gland command more attention than details of the gland itself. The structure that commands the most attention is the facial nerve. The only constant location of the facial nerve is at the stylomastoid foramen posterior and lateral to the base of the styloid process. This is the preferred location to attempt identification of the nerve.

At a point approximately two thirds of the distance from the angle of the mandible the temporomandibular joint, the main trunk divides into temporofacial and craniofacial branches. More distal branching is highly variable and the peripheral branches often are not in the same parasagittal plane with superior branches more superficial than the inferior branches. The nerve is surrounded by a thin sleeve of connective tissue allowing separation of the gland from the nerve. Mobilisation of the posterior surface of the gland is the key to rapid identification of the nerve.  The gland is first separated from the cartilaginous and bony ear canal by blunt dissection following tragal perichondrium until the styloid process can be readily palpated.

Next the gland is separated from the anterior border of the sternocleidomastoid muscle and this separation requires division of the anterior branch of the greater auricular nerve.  If this occurs this can be dissected out and save for use as nerve graft in repairing the facial nerve if resection of part of the facial nerve is anticipated. 

            The gland is reflected forward until the posterior belly of digastric can be seen.  The main facial nerve trunk ties within a triangle formed by the tragal cartilage (posterior): the posterior belly of the digastric and the styloid process.  The dissection should thus continue toward the styloid process from the tragal pointer and the digastric.  The main trunk is usually greater than 1 cm deep to and slightly inferior to the tragal pointer and is surrounded by a small amount of fat – a warning of its proximity.

An alternate technique is to follow the tympanomastoid suture medially.  The main trunk of the facial nerve will be found 6 to 8 mm deep to its drop off point.

In rare situation in which the main trunk cannot be safely approached there are six optional approaches.  Five of these involve identification of peripheral branches and following it retrograde to the main trunk.  The buccal branch is parallel to and 1 cm inferior to the zygomatic arch and slightly superior to the parotid duct.

The marginal mandibular branch can be found by carefully dissecting along the deep surface of the tail of the gland.  Temporal and zygomatic branches can be located by careful dissection along the zygomatic arch.

The cervical branch can be located by dissecting along the posterior deep surface of the tail of the gland.  Finally the posterior facial vein can be located inferior to the gland and followed superiorly until the cervicofacial branch crosses it superficially.

The sixth method involves partial removal of the mastoid process to identify the main trunk prior to its exit from the temporal bone.

Once the main trunk is identified the operation becomes a branch by branch dissection of the nerve using fine tipped haemostat.

Other incisions described for access to parotid are

a)      Adson and Ott described a Y shaped incision with smooth angles.  Thus composed of a preauricular incision starting from upper attachment of helix.  The incision is brought downwards and below the lobule of the ear to reach the anterior border of sternocleidomastoid muscle just below the mastoid process.  From this point incision is carried downwards and forwards along the anterior border of sternocleidomastoid muscle behind mandibular angle.  Then a postauricular incision is made along the junction between skin and auricle and is joined with the preauricular part below the ear lobule. 

b)      In Guteirrez incision there is a temporal extension.

c)      In Redden’s modification temporal extension is avoided.  The extension to mastoid process is lower than that of other incisions.  The post auricular part is away from the ear lobule.

d)     Samengo (1961) described a Y shaped incision with superior aesthetic result.  It involves straight incision lines.

e)      Apprani (1984) suggested another incision.  This includes a temporal component that extends anteriorly and upwards in hair line, a preauricular portion running downwards to the lower end of helix, a postauricular portion behind the helix that smoothly curves over the mastoid process.  This incision is almost completely hidden in hair bearing area. 

f)       Jose Juis Ferreria (1990) described a modified approach to parotid region.  The incision comprises a temporal, preauricular, sublobular, retroauricular, mastoid and cervical sectors.  The temporal portion extend above the upper attachment of helix and curves gently forwards but limited to hair bearing area.  The sublobular sector encircles the lobe, following its contour.  The retroauricular portion ascend behind the ear approximately halfway up to the posterior auricular groove where it begins to curve gently backward towards the mastoid process and there the incision becomes concave and course downwards and forwards along the nape of the neck.  The cervical sector is arcform and run approximately 1 cm within the hair line.  It is slightly concave and ends at the level of an imaginary line projecting from the lower edge of mandible into the lateroposterior cervical area. 

According to the authors there is decreased chance of impaired circulation wound dehiscence and formation of parotid fistula.  Access is excellent and hidden in hair bearing area, so aesthetically superior.

Complication of incision for access to parotid region

  • Potential for facial palsy
  • Potential for Frey’s syndrome
  • Keloid over cervical and mastoid region
  • Oedema of ear lobule
  • Salivary fistula
  • Numbness in temporal region
  • Loss of hair in temporal region


            Approach to TMJ is done by following incisions

1)                  Preauricular (Rowe-1972).

2)                  Postauricular (Alexander and James-1975).

3)                  Endaural (Davidson-1975).

4)                  Intraoral (Sear-1975).

5)                  Temporal (Alkayath & Bramley-1979).

6)                  Submandibular (Risdon-1934).

7)                  Hemicoronal.

Preauricular incision

This is commonly and widely used. It is placed in a skin crease formed by external ear with facial skin. Incisions start at the level of lower border of tragus and running upwards around the external auditory meatus then around the upper attachment of helix. From this point incision is curved upwards and forwards approximately by 1cm. The total length of the above incision is little more than 4 cm. The junction of the upper and lower curved incisions forms a sharp point of skin just anterior to external auditory meatus. This corner is picked up by a  skin hook so that tension can be maintained in the flap during the next stage of dissection.

For better access Rowe (1972) modified the incision by angling the upper relieving incision upwards and forwards at 45º from the point of attachment of the helix lying within the hair bearing area over the temporalis muscle extending if necessary for a further 4 cm. This allows a more extensive superficial flap to be raised and may avoid a traction injury to the upper branches of the facial nerve when wide access is required. Henry (1969) gains access to the joint through a short vertical preauricular incision.

The incision is deepened by blunt dissection first through the insertions of the preauricular muscles and then following the anterior wall of the cartilaginous auditory meatus, which runs slightly downwards, forwards and inwards. The base of the zygomatic arch is identified to the temporomandibular joint. Usually the superficial temporal artery and vein will lie in the tissues anterior to the dissection and are retracted forwards within the flap, should they be encountered. They may be ligated and divided. The main requirement at this stage is to identify the root of zygomatic arch. The periosteum over the root of the zygomatic arch is opened using a vertical incision and a subperiosteal tunnel is created along the outer side of the zygomatic arch, blunt dissection of the periosteum must be employed because sharp dissection can increase risk of damage to facial nerve. Further blunt dissection will reveal the outer wall of the capsule below the zygomatic bone and will reveal the forward and downward sweep of the margin of the glenoid fossa as it runs to the articular eminence. The blunt dissection can be extended anteroinferiorly to expose the anterior part of the capsule and below it’s attachment the condylar neck.

As dissection continues to expose the periosteum margin, capsule profuse venous haemorrhage may occur that is controlled by temporary pressure. The plane of dissection should be confirmed regularly by manipulating the movement of the condyle.

Alkayat and Bramley (1979) suggested a temporal extension of the preauricular incision in the form of a question mark facing forwards. Their modification was based on study of 56 cadavers to identify the relationship of upper branches of facial nerve to the zygomatic arch. The curved part of the question mark of the incision is carried through the skin and superficial fascia to expose the temporal fascia. The full depth of the superficial fascia is reflected with the resulting skin flap.

By blunt dissection downward, the split in the temporal fascia is identified. This is about 2 cm above the zygomatic arch. Now further dissection of the superficial fascia from the temporal fascia is performed.

Commencing at the root of the zygomatic arch, a further incision is made running upwards and forwards through the superficial layer of temporal fascia and once inside this pocket, periosteum on the upper border of the zygomatic arch may be safely incised and turned forwards. It retains continuity with the superficial flap.

The pocket between superficial and deep layers of temporal fascia can be extended as far anteriorly as the frontal process of the zygomatic bone and posteriorly continuous with preauricular incision placed just anterior to external auditory meatus. Wide exposure of TMJ is possible with this technique without excessive traction on the anterior flap thus avoiding injury to the facial nerve. The upper part of the incision gets disguised in the hair bearing area.

Extradural approach

This was described by Davidson (1955) in which skin incision passes downwards and backwards in the cleft between the helix and the tragus and proceeds along the roof of the external auditory canal for approximately 1 cm. The incision is then reversed at the anterior half of the meatal circumference, and at the junction of cartilaginous and bony meati. At this stage, the anterior meatal wall and all the overlying tissues are reflected forwards in much the same way as has been described. The main advantage claimed for this incision is that the scar is hidden, but the access is poor.

Post-auricular approach

Here the incision is made in the groove between the helix and the post-auricular skin so that the entire ear can be reflected forwards after completely dividing the cartilaginous external auditory canal. Advantages include wider exposure and better cosmetic result.

Disadvantages are partial stenosis of auditory canal, possibility of infection and necrosis of auricular cartilages with resultant deformity of pinna.

A modification of post-auricular approach does not involve the division of cartilaginous auditory meatus. It is appropriately described as circum-meatal approach in which components of pre-auricular and post-auricular incisions are incorporated.

The skin incision anterior to the ear commences at the upper border of the tragus and passes upwards in the pre-auricular crease to reach the most superior attachment of the helix to the scalp at which time, the knife blade cuts right down to the underlying bone so that a full-thickness incision including the periosteum is made. This is completed by carrying it backwards and downwards around the outer margin of the funnel-shaped bony auditory meatus to terminate just above the commencement of the mastoid process. The superior and post-auricular muscles are divided in the upper part and brisk bleeding may be experienced that is readily controlled by diathermy.

The tissues posterior to the ear are elevated and sub-periosteal blunt dissection is done to free the cartilaginous auditory meatus from the auditory canal and retract it downwards.

Anteriorly, blunt dissection is done as in the pre-auricular approach to expose the later al aspect of the capsule.

Intra-oral approach

            The incision starts at the level of the upper occlusal plane, carried downwards along the external oblique ridge and then down along the mandibular body.

            The upper tissues are freed by sub-periosteal retraction and a forked ramus retractor is used to pull them upwards. Further sub-periosteal dissection is extended backwards until the neck of the condyle is exposed and then by vigorous blunt dissection and detachment of lower head of lateral pterygoid as much as possible. Gutter-shaped retractors are used to protect the soft tissues. By this approach, accessibility is poor.

Submandibular approach

            It is similar to that for an ideal submandibular incision. Masseter muscle can be reflected off the lateral surface and medial pterygoid on the medial surface. Appropriate retraction exposes the ramus and the neck of the condyle.

            Kasey and Feodor et al have described a combination of pre-auricular incision and a middle fossa craniectomy just above the glenoid fossa for access to the tumours of the glenoid fossa.


Submandibular  incision


1)                  Treatment of fractures of the mandible

2)                  Ramus osteotomies

3)                  Surgical approach to TMJ

4)                  Surgical approaches to submandibular gland

5)                  Drainage of submandibular and sublingual abscesses

6)                  Soft tissue aesthetic surgery as in masseteric hypertrophy

7)                  Removal of submandibular lymph nodes.

The major structures in the way of the incision are

  • Marginal mandibular nerve and the cervical branch of facial nerve,
  • Facial artery
  • Facial vein

Marginal mandibular nerve leaves the antero-inferior part of the parotid gland and runs anteriorly first at the level of the lower border of the mandible. The position of the nerve can vary. In some individuals, it runs just below the mandibular  border and ascends  over the body at the canine region. To avoid damage, submandibular incision should be placed 2 mm below the lower border of the mandible.

The cervical branch runs downwards just posterior to the ramus. This nerve lies superficial to deep cervical fascia in the platysma muscle. Therefore the incision should include the platysma.

The facial vein lies superficial to the deep fascia and is often divided when the ramus is approached.

The facial artery lies below the submandibular gland curving round and appearing at the lower border and the antero-inferior angle of the masseter muscle. The artery is sectioned at this region.

A skin crease in the submandibular region is marked 2cm or 2 finger breadth below the mandibular border by making the skin relaxed. The anterior and posterior extension slightly vary depending on the region to be exposed. The skin  in the area is stretched by extending the head and turning to the opposite direction. Incision is marked either with skin pencil or back of the blade. One or two cross-hatching should be done in order to facilitate proper closure. Then the region is infiltrated with vasoconstrictor. Initial incision should cut the skin and subcutaneous tissue perpendicular to the skin surface to expose the platysma. The tissue is undermined by blunt dissection. After this, the platysma is sectioned at the same level to expose the deep cervical fascia (to avoid damage to marginal mandibular nerve). Then at this plane, the blunt dissection proceeds upwards to reach the lower border where the deep fascia and periosteum is divided. The facial artery will bulge slowly. Then it is clamped, ligated and sectioned.

The incised periosteum can be reflected to expose the mandible. The masseter muscle can be stripped off the lateral surface and the medial pterygoid off the medial surface. With appropriate retraction, the sigmoid notch, the condylar neck, l the lower part of the coronoid process and the anterior border of the ramus may all be exposed.

Advantages of submandibular incision are its wide use when mouth opening is limited, when better exposure and accessibility is required and when intra-oral approach becomes a difficulty in the management of fracture of the angle of the mandible.

Disadvantages are possibility of an unacceptable scar, chances of injury to marginal mandibular nerve resulting in absence of movements at the ipsilateral corner of the mouth.

Risdon’s incision is described for the submandibular approach to the condyle and TMJ. This incision lies just posterior to the standard submandibular incision about one finger breadth below the angle of the mandible. The incision is curved along the angle of the mandible.

What Are The Causes of Cerebral Palsy

Cerebral palsy is not a disease but a condition, just like deaf.Children and adults with this condition should not be called as cerebral palsy children but children having cerebral palsy. Similarly for the deaf, one should speak person is having deafness and not to call him a deaf person.

What Is Cerebral Palsy
Cerebral Palsy is a non progressive neuromuscular disorder causing mild to severe disabilities throughout life.This condition is manifested as a group of persisting qualitative motor disorders which appear in young children due to damage to the brain during delivery or due to some pathological conditions in the intrauterine life.The neuroligical problems are multiple but non progressive in nature.Approximately 2 per 100 live birth is having this problem.This disease is having no hereditary tendency.

Causes of Cerebral Palsy
1.Injury to the brain during delivery.
2.As a complication of forceps delivery.
3.Lack of oxygen supply to the baby during delivery.
4.Infections during delivery.

Signs and symptoms of Cerebral Palsy
The signs and symptoms may not be similar in all babies affected.Depending upon the damage to the brain there may be mild to severe lesions.

1.Mild cases – 20% children will have mild disability.
2.Moderate cases – 50% cases are having moderate disability.
The affected children require self help for assisting their impaired ambulation capacity.
3.Severe cases -About 30% of the affected children are totally incapacited and bedridden.
They always need care from others.

Abnormal findings of Cerebral palsy
1,Abnormal neonatal reflexes.
2,Stiffness of all muscles with awkward motion.
3,Extention of extremities on vertical suspension of the infant.
4,Scissoring of the lower limbs due to spasm of the adductor muscles of the thigh.
5,In severe cases the back bend backwards like and arch.
6,May have total or partial paralysis.
7,Arrest of neurological and behavioral developement.
8,Swallowing may be difficult in some cases.
9,Drooling of saliva.
10,Mild to severe mental retardations.
11,Abnormal movements are seen in some cases.
12,Tremors with typical movements.
13,If cerebellum is affected there will be loss of muscle tone with difficulty in walking.
14,Complete or partial loss of hearing.
15,Speech may be affected.
16,Squint and other visual problems may be associated.
17,Convulsions may be seen in some children.

Cerebral palsy is diagnosed by detailed clinical examination and by eliminating other similar diseases like brain tumour, progressive atrophy ect.All investigations like CT scan,MRI and routine investigations are needed to ruleout other diseases.

Management of Cerebral Palsy

1.General Management – This includes proper nutrition and personal care. Symptomatic medicines are needed to reduce convulsions and muscle stiffness. Diazepam can reduce spasticity and athetosis.
Dantrolene sodium helps to relax skeletal muscles.

2.Physiotherapy – Here massage,exercise, hydrotherapy and ect are needed.Special training is given to train walking,swallowing and talking.The affected children are also trained to hold articles for routine activities.

3.Rehabilitation – Moral and social support should be given to these children.They should be send to special schools where special training can be given by trained staff.Mentally retarded children need special training.Depending up on the disabitity special instruments and machines are given for locomotion and to assist their daytoday activities.

4.Occupational Therapy – This is given by occupational therapists.They train the disabled people to do some suitable works so that these people can have their own income.

Paralysis massage

A) Characteristic sign and symptoms in paralysis:

1. Patient may present as monoplegia (only one limb affected), hemiplegia (one half of body affected with or without involvement of face), paraplegia (both lower limbs affected), or with facial paralysis in which one side of face is affected.
2. General signs include stiffness, loss of all movements of affected limb, loss of individual muscle tone and function, muscle wasting etc. Patient may be unable to walk on his own, may not be able to speak properly and clearly, or experience loss of grip etc.
3. Commonest cause of it is hypertension. Malignant rise in blood pressure leads to hemorrhage in brain and resultant blood clot may press upon nerve fibers causing paralysis of concerned muscles or group of muscles supplied by that nerve. Other causes like multiple infarcts, embolism etc may also lead to paralysis.
4. Slowly the patient recovers from acute stage with partly regaining of some of lost functions like able to speak more clearly, slightly more powerful grip etc. If attack is very mild in nature complete recovery within few days with or without medication is possible.
5. CT scan or MRI brain is the choice of investigation and is helpful to rule out causes like hemorrhage, thrombosis, embolism etc.
6. Though massage is helpful in paralytic patient, if patient presents in acute stage with signs like very shiny skin without application of oil, heaviness in body with more heaviness in affected limb, very cold affected limb, overall signs of indigestion etc then massage is contraindicated.

B) Aim of massage:

1. The disease is difficult to treat and recovery being very slow, main aim of massage is to increase overall body strength as it will provide nourishment to muscles, ligaments etc through increased blood circulation..
2. The unctuous and hot nature of oil will also aim to reduce dryness of stiff muscles, making it soft help to reduce muscle tension and regain its tone.
3. Due to nourishment provided by massage, recovery of lost movements of body and functions might be aimed faster.

C) Process of massage:

1. Body area to be massaged: Usually full body massage is advisable as proper massage will not only provide nourishment to affected body part but will also reduce stress and strain over unaffected part which bears more workload.
2. Direction of massage movements: a. From above down wards especially over limbs and back. b. Individual muscles that are very rigid due to dryness should be massaged with use of fingers giving more pressure, vibrations over it to help more absorption of oil and reduce stress. c. In chronic cases, more friction should be used. d. If CT scan/MRI report shows blood clot in a area in brain, more oil should be used over same part of head and slightly more pressure or friction could be applied over it to help absorption of oil and reduce clot.
3. Useful massage tips: a. Usually in a paralytic patient, massage over limbs in a direction from below upwards should be avoided b. More oil should be massaged in and around navel as well as below navel up to toes in lower limbs in all paralytic patients. c. Oil should be sufficiently warm at the time of massage. d. More quantity of oil as well as more warm oil should be massaged over stiff or rigid muscles in chronic cases. e. Use of thumb over individual muscle or ligaments with pressure and friction is useful. Disease being difficult to treat, regular massage for longer duration like 3-6months or more should be given. Also massage over affected part for longer periods is advisable as compared to other body parts. Daily oil massage will not only act as therapeutic tool and help in faster recovery but will also prevent further attacks.

D) Use of different oils for massage:

1. Oil used for massage should be hot in nature and should be preferably prepared by addition of herbal drugs as per advice of expert physician.
2. Use of herbal drugs like asparagus racemosus, Sida cordifolia etc should be used with sesame oil as base during preparation of medicinal oil as these drugs provide overall nourishment to body especially to body parts like muscles, ligaments etc commonly affected in paralysi

What Causes a Hiatal Hernia?

Hernia Overview
A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity.

Although the term hernia can be used for bulges in other areas, it most often is used to describe hernias of the lower torso (abdominal wall hernias).

There are two types of hiatus hernia:
·    Sliding hiatus hernia – the most common type.  These are small hernias that slide up and down and in and out of the lower chest.
·    Rolling hiatus hernia – this is less common. Part of the stomach pushes up through the hole in the diaphragm next to the oesophagus.

How Do People Get Hernias?
It might take a long time for a hernia to develop or it might develop suddenly. Hernias are caused by a combination of muscle weakness and strain, although the cause of the weakness and the type of strain may vary. Hernias are actually more common in babies and toddlers. And most teens who are diagnosed with a hernia actually have had a weakness of the muscles or other abdominal tissues
from birth (called a congenital defect).

What Causes a Hiatal Hernia?
Most of the time, the cause is not known. Some people develop a hiatal hernia after sustaining an injury to that area of the body; others are born with a weakness or an especially large hiatus. Some experts suspect that increased pressure in the abdomen from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatal hernia.

Signs and symptoms
Small hernias
Most small hiatal hernias cause no problems.
Large hernias 
·    Heartburn
·    Belching
·    Chest pain
·    Nausea

In rare cases
·     Severe chest pain
·    Difficulty swallowing (dysphagia)
·    Obstruction of your esophagus

The most common type of hernia is found in the groin and is called an inguinal hernia. This type of hernia is caused by a loop of bowel pushing through a weakness in the inguinal canal. The inguinal canal is a triangle-shaped opening between layers of abdominalmuscle near the groin.
They are most common in men and male babies, and occur when a loop of bowel slides down the narrow canal down towards the scrotum.
98 out of 100 people who develop a hernia in their groin are male.

Doctors make the diagnosis by examination. Lumps in the groin that resemble hernias may be swollen lymph nodes or undescended testicles. A swelling in the scrotum may be a varicocele (a condition in which the blood supply of the testis develops varicose veins) or a spermatocele (a collection of sperm in a sac that develops next to the epididymis). Sometimes the doctor performs an
ultrasound to help make the diagnosis.

How can a hernia be repaired?
Hernias usually need to be surgically repaired to prevent intestinal damage and further complications. The surgery takes about an hour and is usually performed on an outpatient basis  (which means the patient can go home the same day of the procedure). This surgery may be performed by an open repair (small incision over the herniated area) or by laparoscopic surgery (minimally
invasive). Your surgeon will determine the best method of repair for your individual situation.

Spine Decompression Surgery

Motorcycling, sky diving and scuba diving are a few activities that Jill Misangyi, a registered nurse from Canada, never imagined she would be able to do until her spinal decompression surgery with fusion and instrumentation recently in India through Healthbase . Jill had been suffering from chronic back pain for 16 years.

Back pains are as common as headaches. Most back pains disappear on their own with some rest and / or medication. Some may stay longer but can still be managed with conventional treatments of medication, therapy and back building exercises. But, there are a few types of back pain that are so chronic that they render the person disabled. Such chronic conditions necessitate surgery so as to improve the person’s condition.

There are different reasons that cause backaches. In this article we take a look into conditions caused by compression of the structures that form the spinal column, and the surgical solutions to these spine problems .

Conditions associated with spinal compression are: disc herniation, sciatica, spinal stenosis and spondylolisthesis. To relieve pressure on one or many pinched nerves of the spinal column caused by the compression, spinal decompression surgery in its different forms – discectomy, laminectomy and foraminotomy – is employed. Let us start with a description of each of these conditions followed by an understanding of the surgical options.


  1. Disc herniation: Discs or disks are pads of cartilage between two adjacent vertebrae (i.e. spinal bones) that separate the vertebrae and provide cushioning to them. When the disc herniates (moves out of place), the soft gel inside pushes through the wall of the disc putting pressure on the spinal cord and nerves that are coming out of the spinal column thereby resulting in a severely painful condition. Disc herniation can occur in any disc in the spine – cervical (neck), thoracic (upper back) or lumbar (lower back) region. Disc herniations occur especially in jobs that require lifting, but can also occur from jobs that require constant sitting.

  2. Sciatica: Sciatica refers to pain, weakness, numbness, or tingling in the leg caused by injury to or compression of the sciatic nerve located in the back of the leg. Sciatica is a symptom of another medical problem, not a medical condition on its own. The sciatic nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot. Sciatica may be caused by degenerative disc disease (DDD), pelvic injury or fracture, piriformis syndrome (a pain disorder involving the narrow piriformis muscle in the buttocks), slipped disk, spinal stenosis, tumors, etc.

  3. Spinal stenosis: Affecting mainly middle-aged or elderly people, spinal stenosis is a narrowing of the spinal canal in the lumbar (lower back) or cervical (neck) region that results in compression of the nerve roots. It may be caused by osteoarthritis or Paget’s disease or by an injury that causes pressure on the nerve roots or the spinal cord itself.

  4. Spondylolisthesis: Spondylolisthesis is a condition in which a vertebra in the lower back slips forward and onto a vertebra below it. The slip usually occurs between the fourth and fifth lumbar vertebrae. In adults, it is most commonly caused by a degenerative disease such as osteoarthritis. Other causes are stress fractures (caused during gymnastics), traumatic fractures, and bone diseases.


Depending upon the underlying reason behind the above conditions, surgical decompression might be used to help relieve the pain. Surgical spinal decompression can take the form of a diskectomy, a laminectomy, or a foraminotomy.

  1. Spinal discectomy: Diskectomy or discectomy is the removal of all or part of the affected disc. Spinal discectomy can be done in a few different ways:

    1. Microdiscectomy or microdiskectomy: This is a minimally invasive way of carrying out the discectomy procedure so that the bones, joints, ligaments or muscles of your spine are not touched resulting in faster healing and recovery.

    2. Lumbar diskectomy: Lumbar discectomy, as the name implies, is performed to address conditions of the lumbar spine or lower part of the back. It may also be part of a larger surgery that also includes a laminectomy, foraminotomy, or spinal fusion (fusing the vertebrae together to stop motion at the painful joint).

    3. Cervical diskectomy: Cervical discectomy is performed to treat conditions of the cervical spine or the neck region of the spine. It is most often done with laminectomy, foraminotomy, or fusion.

  2. Spinal laminectomy: A laminectomy is the removal of a small portion of the arch of the vertebra to increase the size of the spinal canal to alleviate the pressure on the spinal cord and the pinched nerve. Laminectomy is most commonly performed to treat spinal stenosis. It is usually done along with a diskectomy, foraminotomy, and spinal fusion. Laminectomy can be done either using the conventional open method or using the minimally invasive method.

  3. Spinal foraminotomy: A foraminotomy is the removal of bone and other tissue to expand the openings for the nerve roots to exit the spinal cord. Foraminotomy, which be performed on any level (region) of the spine, takes pressure off of a nerve in the spinal column and allows it to move more easily. The procedure is commonly performed as a minimally invasive procedure.

Spinal decompression surgery is successful in relieving pressure and pain in 80% to 90% of patients. When your back pain is getting the better of you, a decompression surgery can greatly help improve your quality of life.

As for Jill Misangyi, she feels her life after surgery has taken a total turn around for the good. She is off all pain medication and is back exercising building muscle. Her 16 years of painful prolonged waiting for surgery at an NHS hospital in Canada are wasted but she considers herself lucky to have found out about Healthbase and affordable medical tourism in India. She now has a second chance at life.

Pemf Technology! NASA Secret Now Exposed!

Most people recognize that oxygen, food, and water are extremely essential aspects of well-being. Interestingly, very few folks understand that Magnetic Resonance Stimulation, (sometimes referred to as “MRS” or PEMF with means “Pulsed Electromagnetic Fields”), is also crucial for every living thing on Earth. Actually NASA, (National Aeronautics and Space Administration) and RKA, (the Russian Federal Space Agency), have been using MRS and PEMF Therapy to help prevent magnetic deficiency disorders in their space-traveling explorers for many years. And, since the earliest space missions, many studies have shown that living human tissue and cells absolutely need PEMF.

When these magnetic fields are so important to life as we know it, why haven’t you heard of PEMF or MRS as often as you have the need to drive 8 glasses of water a day? Great question. In the past, people didn’t really need to concern themselves with PEMF. The Earth supplied adequate amounts and people lived a lot differently than we do now. They were outdoors more often and always receiving sufficient quantities of MRS naturally.

Recently, however, modern life has changed the way humans interact with nature and people have altered the Earth’s ability to produce PEMF. People have realized the benefits of PEMF Therapy and have increasingly sought out answers.

In the past, man lived outside or in buildings made of natural materials, (such as huts and adobe homes). Humans also spent a lot of time outside farming crops and hunting. But now, many people spend large quantities of time inside metal and concrete buildings. They work in them, shop in them, and go home to sleep in them. Many people no longer need to farm or hunt

Additionally, the PEMF that our planet IS producing is actually about 50% weaker than it was in the 1700?s. The reasons for this decline are unclear but some scientists believe it is linked to other environmental issues.

Our modern lives also bombard us with unnatural, (aka “bad”) PEMF from PCs, laptops, notebooks, cellular telephones, TVs, mp3 players and other devices

and may spend as little as 10% of their time actually outdoors. In the past, people travelled by horseback or on camels or other animals – outside and in touch with nature. But today, we find ourselves increasingly stuck in cars and subway cars and other metal and plastic and man-made modes of transportation. People also wear shoes, often with rubber soles rather than walking around barefoot or in shoes made from natural materials. All of these things separate us from the Earth’s natural PEMF.

Our bodies are being assaulted on all sides and may be literally starving for PEMF. PEMF bed supplies users with all-natural, Earth based PEMF.

This device allows people to bask in a relaxing bath of natural PEMF which allows to recharge the body’s batteries by restoring a natural balance to the body. The PEMF has been shown to be able to increase energy, improve mental focus, reduce pain, reduce inflammation, and allow folks to sleep better at night. It has also been a successful way to help prevent certain illnesses and even helps to facilitate relaxation and enhance people’s mood.



Pulsed Electromagnetic Field Therapy, PEMF. How does it work?

All living cells within the body possess potentials between the inner and outer membrane of the cell, which, under normal healthy circumstances, are fixed. Different cells, e.g. Muscle cells and Nerve cells, have different potentials of about -70 mV respectively. When cells are damaged, these potentials change such that the balance across the membrane changes, causing the attraction of positive sodium ions into the cell and negative trace elements and proteins out of the cell. The net result is that liquid is attracted into the interstitial area and swelling or oedema ensues. The application of pulsed magnetic fields has, through research findings, been shown to help the body to restore normal potentials at an accelerated rate, thus aiding the healing of most wounds and reducing swelling faster. The most effective frequencies found by researchers so far, are very low-frequency pulses of a 50Hz base. These, if gradually increased to 25 pulses per second for time periods of 600 seconds (10 minutes), condition the damaged tissue to aid the natural healing process.
Pain reduction is another area in which pulsed electromagnetic therapy has been shown to be very effective. Pain signals are transmitted along nerve cells to pre-synaptic terminals. At these terminals, channels in the cell alter due to a movement of ions. The membrane potential changes, causing the release of a chemical transmitter from a synaptic vesicle contained within the membrane. The pain signal is chemically transferred across the synaptic gap to chemical receptors on the post-synaptic nerve cell. This all happens in about 1/2000th of a second, as the synaptic gap is only 20 to 50 nm wide. As the pain signal, in chemical form, approaches the post-synaptic cell, the membrane changes and the signal is transferred. If we look at the voltages across the synaptic membrane then, under no pain conditions, the level is about -70 mV. When the pain signal approaches, the membrane potential increases to approximately +30 mV, allowing a sodium flow. This in turn triggers the synaptic vesicle to release the chemical transmitter and so transfer the pain signal across the synaptic gap or cleft. After the transmission, the voltage reduces back to its normal quiescent level until the next pain signal arrives.
The application of pulsed magnetism to painful sites causes the membrane to be lowered to a hyper-polarization level of about -90 mV. When a pain signal is detected, the voltage must now be raised to a relatively higher level in order to fire the synaptic vesicles. Since the average change of potential required to reach the trigger voltage of nearly +30 mV is +100 mV, the required change is too great and only +10 mV is attained. This voltage is generally too low to cause the synaptic vesicle to release the chemical transmitter and hence the pain signal is blocked. The most effective frequencies that have been observed from research in order to cause the above changes to membrane potentials, are a base frequency of around 100Hz and pulse rate settings of between 5 and 25Hz.
Lecture abstract Dr. D. Laycock, Ph.D. Med. Eng. MBES, MIPEM, B.Ed.

The wonderful magnetic pemf therapy has stunned health professionals a lot. The simple magnetic force which took more than a whole bunch of years for scientists to know is now recognized for its important advantages it gives to the human body. The magnetic force helps in reducing discomfort and ache and thereby, improves the general health. Because of the significance of magnetic discipline on the human physique the scientists have launched units that work on Pulsed Electro Magnetic Pressure or pemf therapy. These units help to enhance the move stage of the blood and it additionally scale back pain. One of the vital frequent problems that large number of individuals faces in their everyday life is that they feel discomfort after they have to sit down for a long time period. A PEMF therapy cushions or mats reduces stress and gives reduction instantly. The cushions or mats provide reduction from other kind of discomfort or physical stress as well. The health problems like indigestion, headaches and strained muscle mass, etc can all be treated with PEMF therapy. The PEMF therapy with its therapeutic effects relieves power pain. The cushion or mat has superior high quality of magnets inside it. These magnets are very secure and likewise very effective. Because the magnetic discipline is available in contact with the physique, a feeling of leisure is skilled and likewise the stress is minimized. Because the physique is relieved from the stress, a brand new vitality gets restored and thus, the physique is energized. The consumer of the PEMF therapy received t be capable of see these magnets but these are positioned in such a way that they offer maximum therapeutic value.

The PEMF therapy additionally helps to combat frequent health problems that most people experience in their regular lives like migraine headaches, menstrual ache, osteoarthritis, power back pains, and etc. A temporary reduction from these problems can be achieved by taking medication but PEMF therapy might result in other health problems. pemf therapy is a secure methodology to eliminate these various problems. There are no negative effects hooked up to these problems and likewise, there is no such thing as a chance of overdose. The PEMF therapy for round 10 to 20 minutes every day may cause drastic change in your health. The PEMF therapy has shown many seen positive affects to our physique like: Decreased ache Improved circulation Improved sleep Nerves regeneration Improves the wound heal capacity Enhanced immunity system of our physique Helps to strengthen bones Prompt reduction from fatigue Reduces stress levels Reduction from muscle pressure.
Anybody can make use of this. Youngsters, adults and previous can profit from PEMF therapy. The pregnant girls and other people with pace makers are suggested to seek the advice of a health care provider before using these. To have a greater idea of assorted PEMF therapy, you possibly can all the time undergo the reviews written by their users.


Diabetes mellitus: Blood sugar level in diabetes slowly reduce when treated with Pulsed Electromagnetic Field. The reduction in blood sugar level can be brought to a near normal or normal stage.

This reduction is mostly because of increased metabolism of glucose in the tissues and increase in the production of insulin in the pancreas and its utilization at the receptor level. gastrointestinal conditions in which PEMF Therapy is effective are GASTRITIS, PEPTIC ULCER, ULCERATIVE COLITIS, IRRITABLE COLON, HEMORRHOIDS etc.

Bronchial Asthma: In this condition the obstruction in the bronchioles are reduced gradually. Liquefies the sputum and facilitates to come out spontaneously. The anti-inflammatory action of PEMF helps in increasing the space inside the bronchitis and there by free air movement takes place. In those patients who have undergone this treatment the Forced Vital Capacity, Forced expiatory Volume and Peak expiatory Flow Rate of the lung has been found increased by 27% and 33% respectively. In case of PEFR the increase was 40%.

At the end of treatment there was no wheezing and dyspnea in almost all cases, other respiratory conditions in which this treatment is effective are COMMON COLD, TONSILLITIS, SINUSITIS, CH.BRONCHITIS, BRONCHIECTASIS etc.

Cardio Vascular Diseases: Let us see how PEMF can be used for the prevention of Heart Attack. In hypertensive people the blood cholesterol level is reduced. Centrally mediated vascular dilatation also helps in the reduction of blood pressure. Increases the circulation of blood in all the blood vessels. This helps to increase the supply of nutrition to all the tissues of the body and also prevents platelet aggregation. Some studies conducted in Russia shows that the thickening of the blood vessels can be reduced in atherosclerotic condition due to the disintegration of plaques. PEMF has a peculiar property of blocking the oxygen free radicals which are responsible for cadic cell damage. All this contribute to prevention of block in coronary arteries which supplies blood to heart, and there by prevents heart attack. Other vascular conditions in which PEMF is effective are PHLEBITIS, ENDARTERITIS, VARICOSE VEIN etc.

Bone and Joint Disorders: The metabolic errors in the connective tissue around the diseased joint is corrected. Hydrozyprolin, hezosamine, creatinine, uronic acid etc are found in increased amount in the urine of these patients. PEMF corrects the metabolic activity in the cells and there by reduction in these abnormal products in urine results. Along with reduction in pain and swelling of the joint, there is an increase in the mobility of the joint. SPEEDY FRACTURE HEALING is an important aspect to be mentioned. Union of the fractured bones takes place almost within half the time required for normal healing. This treatment is effective in OSTEO AND RHEUMATOID ARTHRITIS, CERVICAL SPONDYLOSIS, LOW BACK PAIN including disc displacement, OSTIOMYLITIS and ARTHRITIS of varying etiology.

Brain and Mind Disorders: Keeping the patient in a specific controlled PEMF, with the help of EEG, it has been found out that pre-eminent Alpha Waves are formed in the brain indicating enhanced brain electrical activity suggestive of clam, inward directed restful alertness.

PEMF send into the brain through the skull, by inductive cupping, will induce a current in the area and it stimulates the brain cells. The PEMF also enhance the higher brain functions such as better learning capacity, memory, creative thinking etc. So this is a possible modality of therapy for brain–mind disorders like DEPRESSION, AGGRESSION, ANXIETY, STRESS etc, and conditions like PARKINSONISM, EPILEPSY, MIGRAINE, STROKE, ALZHEIMER’S DISEASE, DEGENERATIVE CONDITIONS OF BRAIN etc.

In children CEREBRAL PALSY, MENTAL RETARDATION, HYPERACTIVITY, LEARNING DISABILITIES ETC can be improved to a better and higher degree of activity by stimulation of PEMF on the Central Nervous System.

Geneto Urinary Conditions: In females conditions like MENSTRUATION IRREGULARITIES, STERILITY, ENDOMETRITIS, ENDOMETRIOSIS etc and in males conditions like ORCHITIS, PROSTATITIS, OLIGOSPERMIA etc can be treated successfully with PEMF.

Skin Diseases and other Conditions: This treatment gives a better result in chronic ulcers and delayed wound healing than any other mode of treatment. In conditions of trauma and physical break down of athletes this therapy will give complete relief. For ECZEMA, NEURODERMATITIS BURNS and such other skin conditions this treatment is very useful.


One sentence answer is by increasing the efficiency of brain cells in synthesizing the neurochemicals required for the transmission of impulses or commands at the synaptic level and by improving the electrical activity of these cells. Brain is a neurochemicals complex. The efficiency of the brain or intellectual capacity of the brain depends upon the efficient performance of the brain cells and production of the chemicals that are called neurotransmitters.

Too much of dopamine can make you hyperactive, while too little it causes or results in uncoordinated movements of limbs (Parkinson’s). Less acetylcholine, a neurochemicals, in the brain is the reason for Dementia especially Alzheimer’s type. If the cells are stimulated repeatedly, after showing inhibition, they rebound and become more active than before. Since PEMF has the ability to stabilise the Genes and prevent the activity of oxygen free radicals formed in the cells, it helps to retard the aging process.

PEMF THERAPY IS VERY EFFECTIVE in almost all acute and chronic diseases. Along with medicines, PEMF therapy go a long way in reducing the duration of treatment and cost of medicines. Since it will reduce the blood cholesterol level, help in the disintegration of etheroma of arteries and increase circulation, this therapy can even be use for the prevention of heart attack.

Nasa Study (Summary)
NASA 4-year collaborative study on the efficacy of electromagnetic fields to stimulate growth and repair in mammalian tissues

CHIEF INVESTIGATOR:Thomas J. Goodwin, Ph.D. Lynden B Johnson Space Center

PURPOSE:This four year study used human donors “to define the most effective electromagnetic fields for enhancing growth and repair in mammalian tissues.”

To utilize “nerve tissue which has been refractory to efforts to stimulate growth or enhance its repair regardless of the energy used.” (all other tissues have demonstrated growth and repair stimulation with appropriate PEMF)

To define a PEMF technology that would “duplicate mature, three dimensional morphology between neuronal cells and feeder (glial) cells, which has not been previously accomplished.”

RESULTS:The PEMF used in the study “caused accelerated growth rate and better organized morphology over controls”, and resulted in “greater cell viability” (85% vs. 65%).

In the gene discovery array (chip technology that surveyed 10,000 human genes), the investigators found up-regulation of 150 genes associated with growth and cell restoration.

T. Goodwin (personal communication) ” PEMF shut down each dysregulatory gene we studied”.NASAs CONCLUSION:

“The up-regulation of these genes is in no manner marginal (1.7-8.4 logs) with gene sites for collagen production and growth the most actively stimulated.”

“We have clearly demonstrated the bioelectric/biochemical potentiation of nerve stimulation and restoration in humans as a documented reality”.

“The most effective electromagnetic field for repair of trauma was square wave with a rapid rate of change (dB/dt) which saw cell growth increased up to 4.0 times.”

They further noted that “slowly varying (millisecond pulse, sine wave) or non varying DC (CW lasers, magnets) had little to no effect.”

Final Recommendation: “One may use square wave EM fields with rapid rate of change for”:

> repairing traumatized tissues
> moderating some neurodegenerative diseases
> developing tissues for transplantation

*the first study to clarify technologies and efficacy parameters for tissue growth and restoration





Magnetism is one of the universe’s fundamental powers. It has been used medicinally in China for over 2,000 years. Our ability to produce and control electro-magnetic fields and to use them to diagnose and treat has expanded enormously with the advent of electricity and electro-magnetics.

PEMF Therapy is the application of electro-magnetic fields to treat and promote health. Although this emerging technology may be new to North America, it has been studied systematically throughout Eastern Europe and in the countries of the former Soviet Union for over 40 years and is a standard treatment for many conditions.

How important is PEMF Therapy? In 1992 Dr. Andrew Bassett, who helped pioneer the first FDA approved device using pulsed electro-magnetic fields, wrote, “In the decade to come bioelectro-magnetics will assume a therapeutic importance equal to, or greater than, that of pharmacology and surgery today. With proper interdisciplinary effort, significant inroads can be made in controlling the ravages of cancer, some forms of heart disease, arthritis, hormonal disorders, and neurological scourges such as Alzheimer’s disease, spinal cord injury, and multiple sclerosis.”

Effects of Magnetic Pulse Therapy have been studied in:

Alzheimer’s Disease • Amyotropic Lateral Sclerosis • Arthritis • Asthma • Atherosclerosis • Bone Healing • Bronchitis • Burns • Cervical Osteoarthritis • Chronic Venous Insufficiency • Dental Problems • Depression • Diabetes • Elbow Pain • Endometriosis/Endometritis • Epilepsy • Eye Disorders • Facial Nerve Neuropathy/Paralysis • Fibromyalgia • Glaucoma • Gynecology • Headache • Hearing Loss • Heart Disease • Herpetic Stomatitis • Hypertension • Insomnia • Kidney Failure/Inflammation/Stones • Knee Pain • Laryngeal Inflammation • Leprosy • Limb Lengthening • Liver/ Hepatitis • Lupus Erythematosus • Lymphadenitis • Mandibular Osteomyelitis • Maxillofacial Disorders • Migraine • Multiple Sclerosis • Muscle Rehabilitation • Muscular Dystrophy • Neck Pain • Nerve Regeneration • Neuropathy • Optic Nerve Atrophy • Osteochondrosis • Osteoporosis • Pain • Pancreatitis • Parkinson’s Disease • Paroxysmal Dyskinesia • Pelvic Pain • Peptic – Duodenal Ulcer • Periodontitis • Pneumonia • Poisoning – Detoxification • Post-Mastectomy • Post-Polio Syndrome • Post-Herpetic Pain • Prostatitis • Pseudoarthrosis • Psoriasis • Rheumatoid Arthritis • Schizophrenia • Seasonal Affective Disorder • Shoulder Pain • Sinusitis • Sleep – Insomnia • Spinal Cord Injury • Stroke • Tendonitis • Tinnitus • Transcranial Magnetic Stimulation • Trophic Ulcer • Tubal Pregnancy • Tuberculosis • Urinary Incontinence • Urinary Inflammation – Trauma • Uterine Myoma • Vasomotor Rhinitis • Vestibular Dysfunction • Whiplash • Wound Healing • Wrinkles.

Besides addressing specific conditions, many health promoting benefits have been reported, including increased energy and availability of oxygen, enhanced transport of ions (calcium, potassium, sodium) across cell membranes, improved circulation, enhanced sleep, pain relief and stress reduction. There is speculation that regular PEMF treatment may increase longevity and quality of life.

Magnetic fields pass through the body as if it were transparent which may account for many, far-reaching and systemic effects.

Reported effects include:

• Vasodilation
• Reduction of edema
• Reduced platelet adhesion
• Fibrinolysis
• Acceleration of enzyme reactions
• Enhanced calcium, sodium and other ion movement
• Muscle relaxation
• Stimulation of nitric oxide production
• Enhanced membrane function
• Enhanced sodium – potassium exchange
• Improved cellular energy
• Immunity changes
• Amino acid changes
• Reduced nerve cell firing
• Repair of soft tissue
• Free radical effects
• Anti-oxidant stimulation
• Brain Function Effects
• Stress Reduction
• Hormonal Changes
• Learning Changes
• Scar Modification
• Enhanced Metabolism
• Water Modification
• Electrolyte Changes
• Bone Healing
• Acceleration of Bone Formation
• Autonomic Nervous System Actions
• Enhanced Oxygenation
• Inflammation Reduction
• Sleep Improvement
• Changes in metabolism of medications
• Liver Function Changes
• Enhanced Wound Healing
• Improved Fertility
• Receptor Binding Changes

Neuritis – Causes, Symptoms and Treatment

Neuritis is a complex process involving inflammation of the nerves, resulting in irritation that interferes with normal nerve function and the areas served. Specifically, it affects the peripheral nerves (those outside the brain, spinal cord, or central nervous system), blocking sensory and motor functions, with pronounced symptoms.

Patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy. Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness. The temporal profile of pain preceding weakness is important in establishing a prompt diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy.


The cause of optic neuritis is unknown. Sudden inflammation of the optic nerve (the nerve connecting the eye and the brain) leads to swelling and destruction of its outer shell, called the myelin sheath. The inflammation may occasionally be the result of a viral infection, or it may be caused by autoimmune diseases such as multiple sclerosis. Risk factors are related to the possible causes.


The main symptoms of neuritis are a tingling and burning sensation, and stabbing pains in the affected nerves. In severe cases, there may be numbness, loss of sensation, and paralysis of the nearby muscles. Thus temporary paralysis, of the face muscles may result from changes in the facial nerve on the affected side. During the acute stage of this condition, the patient may not be able to close his eyes due to a loss of normal tune and strength of the muscles on the affected side of the face.

Optic neuritis is suspected in patients with characteristic pain and vision loss. Neuroimaging, preferably with gadolinium-enhanced MRI, may show an enlarged, enhancing, optic nerve. MRI may also help diagnose multiple sclerosis. Fluid attenuating inversion recovery (FLAIR) MRI sequences may show typical demyelinating lesions in a periventricular location if optic neuritis is related to demyelination.

Visual loss. The extent of visual loss associated with optic neuritis varies. Some people experience severe difficulty seeing, while others might not notice any changes in their vision. Vision loss, should it occur, usually develops over a day to a week and may be worsened by heat or exercise. Vision loss is usually temporary, but in some cases, it may be permanent.

Vestibular neuritis – in most cases, vestibular neuritis is a self-limiting condition that only occurs once in a person’s lifetime. However, some mild dizziness when moving the head may continue for several years following the infection. For the remaining five per cent or so of cases, the symptoms recur. The condition is then considered to be another type of balance disorder, such as Meniere’s syndrome or benign paroxysmal positional vertigo (BPPV).


Since the Optic Neuritis Treatment Trial (ONTT), doctors have discovered that treating patients with intravenous steroid medication (but not oral steroids) reduces the risk of developing MS later on. This finding is very significant since approximately 50% of those who experience an initial occurrence of optic neuritis will develop MS. While this treatment has little if any impact on vision, it is important for overall health.

Pinched Nerve & Premenstrual Syndrome Can Last even for Long Time

The term “pinched nerve” is somewhat of a catch-all phrase that is commonly used to describe the pain associated with a variety of conditions from subluxations, to tunnel syndromes to the referred pain from trigger points.
Most of the time, what is called a pinched nerve is actually an irritated, or inflamed nerve where the nerve itself is not actually pinched. In most cases, nerves become irritated and inflamed when the bones, joints or muscles of the spine are not in their proper position, or are not moving properly. This condition is called a “subluxation”, the treatment of which is the specialty of the doctor of chiropractic.

There are instances when nerves do become ‘pinched’, such as in Carpal Tunnel Syndrome, Sciatica and Thoracic Outlet Syndrome. In each of these cases, injury, spasm or inflammation of the surrounding muscles and connective tissue causes the nerve to become compressed, resulting in pain. These conditions are referred to as “tunnel syndromes.” Treating tunnel syndromes is more complex than treating a simple spinal subluxation, but they usually respond very well to chiropractic care; especially when combined with other physical therapies, such as exercises and stretches.
Trigger points are very tight “knots” of muscle that form when muscles are either chronically overworked or injured, and are often experienced as a pinching or burning pain. Trigger points will commonly cause pain that radiates to other parts of the body, which is also known as referred pain. The successful treatment of trigger points usually requires a combination of chiropractic care, stretching and a form of deep tissue massage called ‘trigger point therapy.’
It is very important that the cause of any form of pain be properly diagnosed. This is especially important when nerves are affected as severe or long term irritation, or compression, of a nerve can lead to permanent nerve damage. If you have been told that you have a “pinched nerve” it is very important that you seek professional care from a doctor of chiropractic as soon as possible. Contact us today!

Premenstrual syndrome (PMS) is characterized by mood swings, swollen abdomen, headaches, back pain, food cravings, fatigue, irritability or depression in the days before a woman’s monthly period. The severity of these symptoms can range from mild to incapacitating and may last from a couple of days to two weeks.
It has been estimated that three of every four menstruating women experience some form of premenstrual syndrome, and it is more likely to trouble women from their late 20s to early 40s. Between 10-20% of all women experience symptoms that are severe or even disabling.
PMS is thought to be a side effect of hormonal changes during the monthly menstrual cycle and can be made worse by stress, decreased serotonin levels in the brain and subluxations in the low back.

Although chiropractic care cannot fix the way your body responds to the hormonal changes that preceed menstruation, several studies have shown that it can help decrease many of the symptoms of PMS without the potential side effects of prescription drugs. Since the nerves that exit the low back are responsible for regulating all of the tissues in the lower abdomen, any pressure or irritation that can be alleviated through chiropractic care can be helpful. Visit our Chiropractic San Jose and Chiropractic Santa Clara……….We can help!

Physiotherapy For Pediatric Disorders

It is a sad day when one has to deal with pediatric disorders in the family.  Most people believe that children should never suffer from physical problems.  Yet, the reality must be faced that pediatric disorders can happen.  The good news is that physiotherapy offers some help for them.  

Unfortunately, there are numerous pediatric disorders.  To name a few, there are: scoliosis, torticollis, Osgood-Schlatter, sports and traumatic injuries, reluctant walkers, developmental disorders, cerebral palsy, and genetic disorders.  

Physiotherapy for scoliosis – a curvature of the spine – consists of exercises to strengthen the back.  Electrical stimulation is used for this type of pediatric disorders.  The stimulation goes directly to the skeletal muscles.  Chiropractic is also used in an effort to straighten the spine.  

Torticollis is a type of pediatric disorders of the neck.  There is a problem with one of the muscles of the neck so that the child is not able to hold his head up straight.  The head will be tilted to one side.  This chin will jut out on the opposite side of the neck.  Physiotherapy can stretch this muscle so that the child can hold his head more normally.  

Spinal cord injuries as pediatric disorders are difficult to treat.  Children often do not want to do the work that is required to stay ahead of the deterioration that can be caused by this condition.  Physiotherapy personnel are challenged to keep the child’s spirits up as they teach them how to exercise with and without special equipment.  

Brain injuries, including cerebral palsy and strokes are pediatric disorders that must be managed delicately.  The neurological system is often not as sturdy as the skeletal or muscular systems.  However, brain injuries also involve these other systems as well.  

A new treatment for these pediatric disorders like brain injuries is using hyperbaric oxygen therapy.  This type of physiotherapy is based on the idea that, in these conditions, there are often parts of the brain that are not working but can be revived.  The HBOT can sometimes revive them.  

Pediatric disorders such as sports injuries and traumatic injuries require different types of physiotherapy based upon the location and severity of the injury.  If a child has repeatedly sprained the same ankle, therapy will necessarily focus on that ankle, as well as any body part that supports or counterbalances that ankle.  Overall strength is important.  

Traumatic injuries require a certain amount of psychological training, as the subject of the accident or other ordeal may bring on such distress that the child does not want to work.  A good physiotherapist will be able to work with such a child.  Traumatic injuries can also be severe enough that the physiotherapist plans a lengthy course of therapy to overcome them.  Pediatric disorders like this require patience from everyone involved.  

The list of pediatric disorders is long and varied.  Not all of them can be helped by physiotherapy at this time.  Right now, physiotherapy can be used in many cases to relieve symptoms or even to reverse damage.  Physiotherapy performs a valuable function in helping children live more normal lives.  

Tips To Make The Most Out Of Your Physician Assistant Program

Physician assistant programs have increased in number of the last few years. There a well over 136 programs in the country to choose from. While PA program does not last as long as physician programs, there is considerable difficulty too in the study of this program. Here are some tips to guide you in your study and in the process make the most out of it.

Much like the Information Technology (IT) field, the medical field also constantly changes when new research reveals new information about a specific health issues. As such, students of this program ought to read up on various reading materials to keep themselves abreast of new findings in this field.

By developing understanding in statistics and medical study design, you are able to judge the quality of studies and know how the various flaws can affect conclusion about a particular issue. Many institutions offering Master programs in PA requires that applicants have a foundation in statistics. As such, you should plan your study in undergraduate level properly. This is because there are cases where students are not able to graduate on time as a result of not taking the stated prerequisites in their undergraduate programs.

In regard to your training experience, you should make sure that you can obtain a good experience by working with a certified PA. Whilst undergoing your training, you should carry a notebook with you so that you can jot down whichever new concepts or terms leant. For instance, you may learn about the words dysarthria and aphonia when attending to a patient with stroke. Just be sure to write down things that you learn and never depend solely on your memory. 

Strep Throat Infection – Signs and Symptoms of Strep Throat Infection

Strep throat, also called acute streptococcal pharyngitis, is an infection with group A streptococcus bacteria that causes a sore throat. Strep throat is most common in children between the ages of 5 and 15, but it affects people of all ages. In addition to throat soreness, signs and symptoms typically include a fever plus tender and swollen lymph glands (nodes) in the neck. Younger children may also complain of abdominal pain.

Strep throat is highly contagious: you and your child may catch it at school, kinder garden, work, from your family members or any group of people. It usually affects people in early spring, winter or the last days of the fall, but it may also occur in other months of the year. You can have this bacterial infection at any age, but most at risk are teenagers and kids.

Strep throat usually requires a trip to the doctor and a dose of antibiotics. But with the proper medical care – along with plenty of rest and fluids – you should be back on your feet in no time.

If you have strep throat infection, you will have a red and painful sore throat and may have white patches on your tonsils.

Infants primarily experience a thick “colorful” (yellow or green) drainage from the nose and possibly a low-grade fever, with fussiness, irritability, and a decrease in appetite.

There may also be dark red lines in the folds of skin. You may get a bright strawberry-red tongue and flushed (rosy) face, while the area around your mouth remains pale. The skin on the tips of your fingers and toes often peels after you get better. If you have a severe case, you may have a high fever, nausea, and vomiting.

Strep throat can be passed from person to person. When a person who has strep throat breathes, coughs, or sneezes, tiny droplets with the strep bacteria go into the air. These droplets can be breathed in by other people. If you come into contact with strep, it will take 2 to 5 days before you start to have symptoms.
Older children generally look and feel awful with strep throat! They can have high fevers, very painful throats, often severe difficulty swallowing, and pus which can sometimes be seen covering the tonsils. These complaints mean that the child should see the doctor right away, as distinguishing viral and bacterial causes of tonsil infection is very important for correct treatment of the infection.

Causes of Throat Infection
Strep throat is caused by Group A streptococcus bacteria and represents an infection and inflammation of the throat. its symptoms which may include nausea, fatigue, discomfort in the abdominal area and high body temperature, may be moderated or severe.
A strep infection causes the throat (pharynx) and the tonsils or adenoids to become irritated, inflamed, and painful.

Streptococcal bacteria are highly contagious. They can spread through airborne droplets when someone with the infection coughs or sneezes. You can also pick up the bacteria from a doorknob or other surface and transfer them to your nose or mouth. Kitchen utensils and bathroom objects are other common sources of infection transmission.
Smoking and heavy drinking, which can damage the lining of the throat, increase the risk of bacterial infection. Frequent heartburn can also encourage throat irritation if the digestive acids rise as high as the throat. People with weak immune systems from HIV/AIDS, diabetes, cancer treatment, or corticosteroid drug use are also at higher risk.

Bronchitis and Tonsillitis- Causes and Diagnose

The condition called bronchitis is the inflammation of the bronchial tree; tonsillitis is the inflammation of to tonsils localized on the posterior side of the mouth. Both diseases are caused mainly by bacteria or viruses, but can also be unleashed by polluting factors or different substances causing irritation. The most common cause of tonsillitis is still the bacteria Streptococcus with its preferred localization in the mouth and throat.

In bronchitis, the occurred inflammation affects the cills on the bronchial mucosa and lowers their movements so they cannot evacuate mucus and foreign particles no more. Also the mucus secretion is stimulated and the phenomenon of coughing appears during bronchitis. Triggers of bronchial inflammation are especially inhaled dust or pollutants, smoking, but also viral determinants such as Rhinoviruses, Adenoviruses, Influenza and Epstein-Barr.

Tonsils have an immune and evacuating function but viral or bacterial infection hinders the drainage leading to inflammation and pain. Most important infectious factors in tonsillitis are Streptococcus group A and viruses like Herpes simplex I, Adenovirus, Enterovirus, Epstein-Barr and the flu causing viruses Influenza and Parainfluenza.

The primer symptoms of bronchial inflammation are coughing with mucus expectoration, chest pains, dispneea (difficult breathing) and all signs of regular colds. Tonsillitis is characterized by symptoms like a sore throat and disfagia (pain while swallowing), fever, pain, nausea, anorexia and chills.

Most difficult to diagnose is bronchitis as it can easily be mistaken with asthma. Proper tests for diagnose are chest X-ray, listening breathing with the stethoscope, pulmonary function tests and collecting sputum for bacterial cultures.

Tonsillitis is diagnosed only by checking the swollen tonsils with a spatula and collecting a pharyngeal probe to determine if the infection is bacterial or viral. Bacterial infection will require antibiotics but viruses won’ respond to such treatment.

If not treated bronchitis can become chronic and increase the risk of lung cancer, contribute to apparition of asthma or make the pulmonary tract more vulnerable to infections. Complications of untreated tonsillitis might be obstruction of mouth and upper airways and an abscess that could spread in the entire body. Especially untreated Streptococcus causes heart, kidney, skin and liver damages.

Treating bronchitis requires painkillers like Ibuprofen or Acetaminophen, assisted breathing in acute bronchitis and ant biotherapy with macrolides if Chlamydia or Mycoplasma are present.

Streptococcus in tonsillitis must be attacked parenteral Penicillin; in severe cases of more than six tonsillitis attacks per year surgery to remove the tonsils is indicated. Tonsillectomy is also necessary when the inflammation obstructs the throat.

The potential severe complications of long-term infection left untreated must imply more interest in healing the inflammation and treating the primer infection. Researches to find better and right cures are made all over the world.

More informations about asthmatic bronchitis or bronchitis symptoms can be found by visiting

Defeat Diabetes Mellitus

Diabetes is a metabolic disorder that is characterized by high blood sugar and insulin deficiency/inaction.Insulin, which is secreted by the pancreas, facilitates glucose to enter body cells to give them energy. It is also needed to synthesize proteins and store fats. In uncontrolled diabetes, glucose and lipids (fats) remain in the blood stream and in course of time damage almost all organs of the body and also cause heart disease.Diabetes acts on the body gradually and is therefore called the ‘silent killer’. Even the heart attack that occurs to a diabetic is supposed to be painless and hence more dangerous because the patient dies, not even realizing what has befallen him. The organs most likely to be affected are kidneys, eyes, feet, and the heart.

The number of persons suffering from diabetes is rising rapidly, the main reason being the change in lifestyle involving more stress and strain, less exercise and food which does not contain fiber and essential nutrients. Diabetes can be broadly classified into two types: Type 1 diabetes also known as insulin dependent diabetes mellitus or juvenile-onset diabetes accounts for 5% to 10% of cases .Type 2 diabetes called maturity-onset diabetes or non-insulin dependent diabetes mellitus. It is Type 2 diabetes that accounts for overwhelming
majority of diabetes cases.

The classical symptoms of the disorder are as under:
Frequent urination
Excessive thirst
Unexplained weight loss
Extreme hunger
Sudden vision changes
Tingling or numbness in hands or feet
Feeling very tired much of the time
Very dry skin
Sores that are slow to heal
More infections than usual.

Because of its devastating effect on the body organs, the management of diabetes is one of the most important subjects in clinical practice. Blood sugar level has to be kept under control with oral medicines or insulin. In Type 1 diabetes there is no alternative other than insulin. But in Type 2 diabetes oral medicines can also be used to control the blood sugar level. However, oral drugs have adverse side effects and the body also develops resistance after some time. Then there remains no alternative but to submit to insulin and daily injections.

Proper diet and exercise help to a large extent in keeping diabetes under control. Regarding diet and exercise, the following points are important:
avoid having large meals in a day. Try eating small divided meals as this helps to control the blood sugar levels
use sugar as well as salt in moderation
eat foods rich in fiber such as fruits, vegetables, beans and cereals
take limited carbohydrate diet as this raises blood sugar level
restrict meat, oils, dairy products as they contain more fat, thereby raising your weight and risk of heart disease.
exercise for better sugar level control. Daily workouts will keep you healthy and fit
bicycling, jogging, swimming, badminton, tennis, stair climbing, fast walking and running are some forms of exercise
walk to the mall, shopping centers, climb stairs; these will help in achieving/maintaining normal body weight and also maintain normal blood sugar level
proper time to exercise will be 1 to 3 hours after a meal or snack but do not exercise when you are not well.

Apart from the above, there is one more thing which is equally important – proper care of your feet. Take care of your feet as you take care of your face. Wear good quality, well-fitting, soft and comfortable shoes and clean socks. And avoid walking bare foot even when you are indoor.

 As per medical science, diabetes can only be kept under control; it can never be cured. But some individuals have found ways not only to control the syndrome but also to reverse it. If you want to use the escape route please visit the following site and get your redemption there:

Symptoms and Causes of Juvenile Diabetes

Juvenile diabetes mellitus is now more commonly called Type 1 diabetes. It is a syndrome with disordered metabolism and inappropriately high blood glucose levels due to a deficiency of insulin secretion in the pancreas.

Juvenile Diabetes is believed to be an autoimmune disorder. There is also a strong hereditary component to juvenile diabetes. Researchers believe an environmental trigger or virus causes the body to attack the beta cells in the pancreas. Once these cells are destroyed the body can no longer produce insulin.

Diabetes is the primary reason for adult blindness, end-stage renal disease (ESRD), gangrene and amputations. Overweight, lack of exercise, family history and stress increases the likelihood of developing diabetes. When blood sugar level is constantly high it leads to kidney failure, cardiovascular problems and neuropathy. Patients with diabetes are 4 times more likely to have coronary heart disease and stroke. In addition, Gestational diabetes is more dangerous for pregnant women and their fetus.

Rapid weight loss is one of the first symptoms of diabetes, especially if the child also has increased hunger, especially after eating. Other Symptoms include: frequent urination; dry mouth; fatigue; blurred vision and numbness or tingling of the hands or feet.

Juvenile diabetes is a chronic health problem for children. There are many myths and misinformation about diabetes. There is also confusion between juvenile diabetes, also known as type 1 diabetes, and type 2 diabetes. The symptoms for both are for the most part the same, however, the cause and treatment is very different.

Juvenile diabetes can affect anyone of any age, but is more common in people under 30 years and tends to develop in childhood. Other names for juvenile diabetes include Type I diabetes and insulin dependent diabetes mellitus (IDDM). Common symptoms of diabetes and, more specifically, on symptoms of juvenile diabetes. Causes of diabetes are discussed, as well as testing and dietary issues.

The risk of juvenile diabetes is higher than virtually all other severe chronic diseases of childhood. Juvenile diabetes tends to run in families. Brothers and sisters of a child with juvenile diabetes have at least 100 times the risk of developing juvenile diabetes as a child in an unaffected family.

The symptoms of juvenile diabetes, also known as Type 1 diabetes, and Type 2 diabetes are extremely similar, but the two are caused by very different bodily malfunctions. It is important to know which type the individual is afflicted with in order to provide the right treatment, which also varies between types.

It’s not always apparent that a child has type 1 or juvenile diabetes. Some of the symptoms seem like average childhood problems that occur. Nausea and/or vomiting can be misconstrued as the flu. Irritability, being tired and listless may be attributed to behaviors all children exhibit at one time or another. The discovery of juvenile diabetes may happen during a visit to a physician for another ailment such as a vaginal yeast infection for girls or even a routine examination.

Juvenile diabetes is the idea that it can be caught from another person. Juvenile diabetes, along with the other types of the disease, is absolutely not a contagious disease. Another misconception about the disease is the traditional belief that eating sweets can directly cause diabetes. In a way, eating too much sweet may eventually cause diabetes because doing so can lead to obesity. But eating sweets does not cause diabetes. Stress is never a cause of juvenile diabetes or any type of diabetes.