In this article, we will discuss Tympanosclerosis. So, let’s get started.


It is characterised by white plaques occuring in the tympanic membrane and surrounding ossicles. It results from healed chronic otitis media (sequalae of chronic otitis media). There is hyaline degeneration of middle ear mucosa which undergoes calcification and appears like the flakes of white snow.


  • Treat the basic causative factors like disease of the nose, sinuses or pharynx
  • Valsalva maneuver or Eustachian catheterization may be performed
  • Myringopuncture: Injection of air into the middle ear may provide relief
  • Myringotomy: The glue in the middle ear is aspirated
  • Grommet: In recurrent cases a temporary Teflon tube is inserted for ventilation through the ear drum
  • Adenoidectomy (in obstructive case)
  • Tympanoplasty/ossiculoplasty
  • Hearing aid
  • Antibiotic, decongestants, steroids, mucolytic are used.

Post Burn Contractures

In this article, we will discuss Post Burn Contractures. So, let’s get started.

Post Burn Contractures

The tissue defect in burns is filled by granulation tissue. This consists of mainly blood vessels, inflammatory cells, fibroblasts, and myofibroblasts. This myofibroblasts are responsible for wound contraction. The traction force produced by myofibroblasts used to realign the extra-cellular matrix (collagen). The myofibroblasts production is totally depend on cytokines or growth factors released by platelets and inflammatory cells. Reduced level of cytokines promotes apoptosis of myofibroblasts, which in turn reduces the severity of contraction. This will happen if the wound is closed early. Contraction of the wound is helpful in healing as it reduces the size of the wound.

Types of contractures

  • Intrinsic contracture: When a contracture is directly responsible for the deformity; it is known as intrinsic contracture.
  • Extrinsic contracture: When a contracture band is away from the deformed structure and is indirectly responsible for the deformity; it is known as extrinsic contracture. Examples are ectropion of lower eyelid due to contraction of wound over the cheek, ectropion of the lower lip due to neck contracture.

Advantages and Disadvantages of Laparoscopic Surgery

In this article, we will discuss the Advantages and Disadvantages of Laparoscopic Surgery. So, let’s get started.

Laparoscopic Surgery

It is the execution of established surgical procedures via telescopes and within the closed confines of abdominal cavity.


  • Less post-operative discomfort
  • Quicker recovery times
  • Shorter hospital stays
  • Earlier return to full activities
  • Much smaller scars
  • Less internal scarring
  • Less wound infection


  • Expensive equipment
  • Need for specialist (Laparoscopic Surgeons)
  • Requires more training and practice
  • Cannot be a choice all the time
  • Poor depth perception for surgeon
  • Fulcrum effect of tools
  • Loss of dexterity

Types of Drains

In this article, we will discuss various Types of Drains. So, let’s get started.


Open drains

  • Include corrugated rubber or plastic sheets
  • Drain fluid collects in gauze pad or stoma bag
  • The risk of infection is high
  • Eg. Corrugated drain, Penrose drain, Yeates drain

Closed drains

  • Consist of tubes draining into a bag or bottle
  • They include chest and abdominal drains
  • The risk of infection is low

Closed passive drains, e.g. Pig-tail Catheters, Percutaneous transhepatic biliary drains, Urinary Catheters, Intercostal catheter

Closed suction drains, e.g. Bellovac drain, Blake drain, Exudrain, Hemovac drain, Jackson-Pratt drain.

Kocher Subcostal Incision (Theodore Kocher), Chevron (Roof Top), and The Mercedes Benz Modification

In this article, we will discuss the Kocher Subcostal Incision (Theodore Kocher), Chevron (Roof Top), and The Mercedes Benz Modification. So, let’s get started.

Kocher Subcostal Incision (Theodore Kocher)

It gives good exposure to the gall bladder and biliary tract and can be made on the left side to access the spleen. The subcostal incision is started at the midline, 2-5 cm below the xiphoid process and extends downwards, outwards, and parallel to and about 2.5 cm below the costal margin.

Chevron (Roof Top) Modification

The incision is continued across the midline as a double Kocher incision or roof top approach (Chevron Incision), which provides excellent access to the upper abdomen. This is useful in total gastrectomy, operations for renovascular hypertension, total esophagectomy, liver transplantation, extensive hepatic resections, and bilateral adrenalectomy.

The Mercedes Benz Modification

This incision consists of bilateral low Kocher’s incision with an upper midline limb up to and through the xiphisternum. This gives excellent access to the upper abdominal viscera and, in particular to all the diaphragmatic hiatuses.