This picture shows important anatomy involved in endoscopic endonasal surgery. The pituitary gland sits at the top of the picture behind the sphenoid sinus.


A lobectomy of the thyroid gland


A total thyroidectomy


Medical science has advanced significantly since 1507, when  Leonardo da Vinci  drew this diagram of the internal organs and vascular systems of a woman.


Infrarenal aortic occlusion imaged with magnetic resonance angiography (MRA).


The aorta is the largest artery in the body and the  descending aorta  has both a thoracic and an abdominal component. A  thoracic aortic aneurysm  is located in the chest, and an  abdominal aortic aneurysm  is located in the abdomen. Not pictured here are aneurysms which span both cavities and are referred to as thoracoabdominal aortic aneurysms.


Early classification schemes of aortic dissection. Stanford type A are those which originate in the ascending aorta whereas Stanford type B originate distal to the  left subclavian artery  (descending aorta). The Debakey classification describes where the original tear is and the extent of the dissection.


A thoracic aortic stent graft, seen on chest X-ray which was placed during a TEVAR procedure.


Carotid ultrasound.


Carotid endarterectomy.


A medical illustration of lower extremity varicose veins.


Abdominal aortic aneurysm location


A plate from  Gray's Anatomy  with yellow lines depicting the most common infrarenal location of the AAA


3D file showing an aortic aneurysm


Abdominal aortic endoprosthesis, CT scan, original aneurysm marked in blue


Abdominal aortic aneurysms (3,4 cm)


CT  reconstruction image of an abdominal aortic aneurysm


A 6.5 cm AAA with a 3 cm lumen


Open infrarenal aortic repair model, showing a surgical clamp above the aneurysm and below the renal arteries


Blood penetrates the intima and enters the media layer.


Histopathological image of dissecting aneurysm of the thoracic aorta in a patient without evidence of Marfan syndrome: The damaged aorta was surgically removed and replaced by artificial vessel, Victoria blue and HE stain.


Aortic dissection on CXR: Note is made of a wide  aortic knob .


MRI  of an aortic dissection  Aorta descendens with dissection Aorta isthmus


Closure of the lumen of a Type B aortic dissection following medical management


An arteriovenous graft serving as a fistula for hemodialysis access


The  carotid artery  is the large vertical artery in red. The blood supply to the  common carotid artery  starts at the arch of the  aorta  (left) or the  subclavian artery  (right). The common carotid artery divides into the  internal carotid artery  and the  external carotid artery . Plaque often builds up at that division, and a carotid endarterectomy cuts open the artery and removes the plaque.


Illustration depicting a Carotid Endarterectomy


Micrograph  of a cholesterol embolus showing the characteristic cholesterol clefts ( biconvex  white spaces) and a giant cell reaction.  Kidney biopsy .  H&E stain .


An AV fistula.


Surgically created AV fistula


Abdominal aortic endograft on a CT scan; original aneurysm marked in blue


An example of a physician-modified aortic endograft with fenestrations added to accommodate the visceral branch arteries


Artist's rendering of a branched/fenestrated EVAR in the visceral segment  of the aorta above an abdominal aortic aneurysm


Venous external support made of cobalt chromium alloy mesh.


Simulated open aortic surgery for an infrarenal aortic aneurysm. The clamp seen is above the aneurysm and below the renal arteries


Simulated clamp placement for open repair of an infrarenal aortic aneurysm


Simulated proximal suture line using "parachute" technique for an open infrarenal aortic aneurysm repair


Completed proximal suture line of a simulated infrarenal open aortic repair with a dacron bifurcated graft


Example of pitting edema in a person with liver failure


Blood is collected from a vein by a phlebotomist


Angiograms of a patient diagnosed with popliteal artery entrapment syndrome of the left lower extremity. Image A shows a neutral popliteal artery before provocative maneuvers. Images B and C show the obstruction (orange arrows) enhanced with provocative maneuvers of plantar flexion and dorsiflexion, respectively.


The side-to-side and end-to-side portacaval shunts are extrahepatic shunts shown in the lower left of the image.


Sclerotherapy


Doppler ultrasound of subclavian steal phenomenon


Angiogram of subclavian steal phenomenon before and after stent placement


CT angiography of subclavian steal phenomenon


Steps in a TIPS procedure: A) portal hypertension has caused the  coronary vein  (arrow) and the  umbilical vein  (arrowhead) to dilate and flow in reverse. This leads to varices in the esophagus and stomach, which can bleed; B) a needle has been introduced (via the jugular vein) and is passing from the hepatic vein into the portal vein; c) the tract is dilated with a balloon; D) after placement of a stent, portal pressure is normalized and the coronary and umbilical veins no longer fill.


How a varicose vein forms in a leg. Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg.


Comparison of healthy and varicose veins


Hugh Owen Thomas , a pioneer of modern orthopedic surgery


X-ray of a  hip replacement


This image, taken in September 2006, shows extensive repair work to the right  acetabulum  six years after it was carried out (2000). The onset of arthritis, a bone/joint disease, has made further joint damage visible.


Radiography  to identify eventual  bone fractures  after a knee injury


Orthopedic implants to repair fractures to the radius and ulna. Note the visible break in the ulna. (right forearm)


Anterior and lateral view x-rays of fractured left leg with  internal fixation  after surgery


Ligament Advanced Reinforcement System (LARS) artificial ligament. The two end sections are the intraosseous portions and center portion is the intra-articular region.


PET artificial ligament coated with hyaluronic acid coating. Collagen tissue infiltration is evident.


Rate of knee injury among patients with failed ligament augmentation and reconstruction system


An x-ray of intramedullary nailing in a tibial fracture


A person getting a CT scan.


The  SL angle  is an indicator of dorsal intercalated segment instability deformity (DISI). The SL angle goes between: [ 1 ]   - A line through the long axis of the  scaphoid bone .  - A line perpendicular to the distal articular surface of the  lunate bone .  It should normally be 30°-60°. [ 1 ]


Biospace Med logo


oneFIT Medical logo


ALARA logo


The Tree of  Andry


A spinal muscle exercise performed by lying in the prone position and performing alternating shoulder flexions and hip extensions


A Chêneau brace achieving correction from 56° to 27° Cobb angle


A pair of AFO (Ankle Foot Orthosis) braces being used to aid bilateral  foot drop


Codification of Orthoses


Patient after  spinal cord injury  with incomplete paraplegia (lesion height L3) with a knee-ankle-foot orthosis with an integrated stance phase control knee joint


Description of the functions of the large muscle groups used to define the functional elements of a paralysis orthosis intended to compensate for restricted muscle functions


The Amsterdam Gait Classification facilitates the assessment of the gait pattern in CP patients and patients with traumatic brain injury and helps to determine the gait type.


The N.A.P. Gait classification facilitates the assessment of the gait pattern in stroke patients and helps to determine the gait type.


Determination of the strength levels of the large muscle groups, taking into account the muscular fatigue typical of MS patients using the example of the muscle group of the dorsal extensors


Ankle-foot orthosis for the care of patients after  stroke ,  cerebral palsy ,  multiple sclerosis  and other paralyzes of the dorsiflexors and plantar flexors. Designation of the orthosis according to the body parts included in the orthosis fitting: ankle and foot, English abbreviation: AFO for ankle-foot orthoses.


Ankle-foot orthosis (AFO) manufactured using old technology from polypropylene in a variant that is also called "Hinged AFO". It can be used to support an isolated  foot drop , but it will block plantar flexion. This AFO cannot transmit the high forces required to counterbalance weak plantar flexors while standing and walking.


Knee-ankle-foot orthosis for the treatment of patients e.g. with paraplegia after  spinal cord injury ,  poliomyelitis  or  multiple sclerosis . Designation of the orthosis according to the body parts included in the orthosis fitting: knee, ankle and foot, English abbreviation: KAFO for knee-ankle-foot orthoses.


A custom ankle-foot orthotic (AFO) specifically designed and fabricated based on a runner's individual foot and ankle anatomy and biomechanics


Knee orthosis with toothed gear segment joints for the care of patients e.g. after a cruciate ligament tear. Designation of the orthosis according to the body parts included in the orthosis fitting: the knee, English abbreviation: KO for knee orthoses.


Knee bandage/Knee brace


Measurement of pelvic tilt during physical examination to determine whether spinal orthoses are indicated to treat  scoliosis


Halo brace used to immobilize the cervical spine


Jewett hyperextension body brace fitted to adolescent female patient in full support body suit. Designated TLSO as the orthosis fits the thoracic, lumbar and sacroiliac regions, making for a thoraco-lumbo-sacral orthosis.


AFO  for a child. It can be used to support an isolated  foot drop  by blocking the plantar flexion with all negative consequences. (Designation of the  orthosis  according to the body parts included in the orthosis fitting: ankle and foot, English abbreviation: AFO for  ankle-foot orthoses ) The photo does not show the most modern manufacturing technology. Such orthoses were also called Hinged-AFO or orthopedic splint.


An example of Stimson maneuver. The person is lying on their stomach with a 4 kg weight tied to their wrist.


Cunningham technique


Ear inspection


A 40-watt CO 2  laser used in otorhinolaryngology


Royal National Throat, Nose and Ear Hospital  founded in 1874, in  London


Axial section of the Brainstem (Pons) at the level of the Facial Colliculus


The Clivus


Limitation of  abduction  of the right eye. This individual tries to look to his right, but the right eye fails to turn to the side.


The accessory nerve supplies the  sternocleidomastoid  and  trapezius muscles


3D still showing adenoid hypertrophy.


Removed adenoid


Tip of a dilatation catheter with deflated balloon.


Base of the skull. Inferior surface,  attachment of muscles  marked in red.


Exobasis


Endobasis-resistances beams


Endobasis-resistances nodes


The foramina in the base of the skull are exit and entry points for veins, arteries and  cranial nerves .


The cranial nerves as they exit through various foramina.


Facial nerve : the facial nerve's nuclei are in the  brainstem  (represented in the diagram by "θ"). Orange: nerves coming from the left hemisphere of the brain, yellow: nerves coming from the right hemisphere. Note that the forehead muscles receive innervation from both hemispheres (yellow and orange)


Scottish neurophysiologist Sir Charles Bell was the first author to describe the anatomical basis for facial paralysis, and has since served as the eponym for Bell's palsy.


A sound processor behind the ear


An implant shown in actual size in adult hand


Diagram showing the origin of the upper part of the buccinator muscle to the maxilla (the middle part originates from the  pterygomandibular raphe , where buccinator joins the  superior constrictor muscle )


Diagram showing the origin of the lower part of the buccinator muscle on the lateral surface of the mandible


An abscess originating from a tooth which has spread to involve the buccal space. Above, deformation of the cheek on the second day. Below, deformation on the third day.


Diagram showing muscles of infra-orbital region. The levator labii superioris muscle is colored red.


Diagram showing muscles of the infra-orbital region. Levator anguli oris is colored red. The canine space is situated between the levator anguli oris muscle and the levator labii superioris muscle.


An 1896 ad for Elys Cream Balm, a catarrh remedy


The choanae (internal nostrils) of a cat, indicated by the dashed lines and bounded by the  vomer  (blue gray) and the  palatine bone  (orange)


The wide field view of the endoscope allows "looking around the corner" while utilizing the natural ear canal access to cholesteatoma.


Right chorda tympani nerve, viewed from lateral side


A baby being fed using a customized bottle. The upright sitting position allows  gravity  to help the baby swallow the milk more easily.


A repaired cleft palate on a 64-year-old female


Moche pottery


3D model of cochlea and semicircular canals


Structural diagram of the cochlea showing how fluid pushed in at the oval window moves, deflects the cochlear partition, and bulges back out at the round window.


1994 body-worn Cochlear Spectra processor. Early cochlear implant users utilized body-worn processors like this one


Cochlear implant recipient utilizing a behind-the-ear processor


Robin Michelson - Early creator of the Cochlear Implant


Internal components of a conventional device (not yet implanted)


Fig. 1 Cranial sutures viewed from top of head


Fig. 2 Skull deformities associated with single suture synostosis


Fig. 3 Locations of the incisions used in fronto-supraorbital advancement.


Fig. 4 Bone segments that are removed in fronto-supraorbital advancement


From left to right, Keros type I, II, and III.


Cystic hygromas are classically found in the  posterior triangle  of the neck.


Newborn infant with a cystic hygroma visible on right side of the neck


The four compartents of the right masticator space.  A  Temporalis muscle,  B  Masseter muscle,  C  Lateral pterygoid muscle,  D  Medial ptaerygoid muscle,  E  Superficial temporal space,  F  Deep temporal space,  G  Submasseteric space,  H  Pterygomandibular space,  I  Approximate location of infratemporal space.


An  audiologist  conducting an  audiometric   hearing test  in a  sound-proof  testing booth


Anterior view of digastric muscle


Zinc Gluconate.


Eprosartan .


Diver clearing ears


Section of the human ear, the Eustachian tube is shown in colour


Ear hair protruding from the  external auditory meatus  in a middle-aged male. Note the fine  vellus hair  growth on the  antitragus  and  helix .


Ear hair protruding from the  external auditory meatus  in a middle-aged male.


Strand of human hair at 200× magnification


Royal Navy   admiral  Michael Denny  with ear hair


Otitis media


Referred otalgia from neck and head sources [ 31 ]


Acute ear pain decision tree [ 4 ] [ 8 ] [ 9 ]


Chronic ear pain decision tree [ 4 ] [ 8 ] [ 9 ]


Professor Anton Friedrich von Tröltsch 1869 O. Roth, Inventor of the otoscope


Drawing (left image) and CT scan (right image) of the normal pharynx as a cross-section viewed from the side (sagittal view), including the normal epiglottis (orange arrow), opening to the esophagus (yellow arrow), and opening to the trachea (blue arrow). An infected epiglottis becomes swollen and causes issues with swallowing, speaking, and breathing due to its proximity to the esophagus and trachea. Other labeled structures include the tongue (pink arrow) and vertebral bodies of the cervical spine (grey arrow)


Upper respiratory system, showing  entrance to auditory tube  near middle


The Eustachian tube has recently been redefined as the  fibrocartilaginous structure connecting the air cell system of the temporal bone to the nose. What was thought of as the bony tube is really part of the air cell system of the temporal bone. [ 4 ]


3D reconstruction of the right Eustachian tube from Valsalva CT. Note the sac like shape of the structure.


3D reconstruction of the air cell system of the temporal bone including the Eustachian tube and its narrowest area in close proximity to the ear, the isthmus


Branches of external carotid artery.


Left external carotid artery with normal spectral doppler ultrasound


Superficial dissection of the right side of the neck, showing the carotid and subclavian artery. Branch of facial artery labeled


The  facial nerve


Basic human airway anatomy. Objects can enter the trachea and lungs via the mouth or nose.


Section of larynx showing aspirated fragment of meat (top center).


Chest x-ray of an adult with obstructive pneumonia in the right lung (left side of the image) evidenced by hypodense (less dark) area. This is from a blockage in the respiratory tract leading to an infection distal to the obstruction.


X-ray of focal pneumonia in lower right lung lobe (bottom left of chest in image) due to aspiration and airway obstruction.


Foreign body aspiration of a coin in the esophagus.


Frontal sinus.


Heinz Stammberger at the end of course at Tarabichi Stammberger Ear and Sinus Institute two months before he died.


Professor Stammberger teaching at the Tarabichi Stammberger Ear and Sinus Institute


Squamous cell carcinoma of the mouth


Radiation mask used in the treatment of throat cancer


Age-standardized  death from oro-pharyngeal cancer per 100,000 inhabitants in 2004 [ 122 ]      no data      less than 2      2-4      4-6      6-8      8-10      10-12      12-14      14-16      16-18      18-20      20-25      more than 25


Head mirror


A doctor using a head mirror to illuminate his patient's nasal passages.


A deaf person using a camera-equipped smartphone to communicate in sign language


An  audiologist  conducting an  audiometric   hearing test  in a  sound-proof  testing booth


An in-the-canal hearing aid


Disability-adjusted life year  for hearing loss (adult onset) per 100,000 inhabitants in 2004:             no data      <250      250–295      295–340      340–385      385–430      430–475          475–520      520–565      565–610      610–655      655–700      >700


The sign for "friend" in  American Sign Language


This portrait, though undated, supports the view that tracheotomy was practiced in  ancient history


Hieronymus Fabricius ,  Operationes chirurgicae , 1685


William Beaumont  (1785–1853), American  physiologist


The laryngoscopy. From  García , 1884


Engraving  of French  pediatrician   Eugène Bouchut , by Henri Brauer. From  Angelo Mariani  and Joseph Uzanne (1894).  Figures contemporaines tirées de l'Album Mariani , Volume I. Paris:Ernest Flammarion.


Glidescope video laryngoscope, incorporating a  CMOS   active pixel sensor  (CMOS APS)  video camera  and a  high resolution   LCD monitor


Electron micrograph  of Human Papilloma Viruses


Basaloid pattern of  squamous cell cancer


Genomic structure of HPV


Rhinoscope used in diagnosis and surveillance


CT scan  in  transverse plane , viewed from below, showing a contrast enhancing right  tonsil  mass due to HPV+OPC


Vial of  HPV vaccine


Transverse radiation contours used in treating cancer seen on above CT scan and in machine set up below


Types of oropharyngeal cancer and associated survival rates


The lesser and greater horns of the hyoid


The hyoid bone sits above the  thyroid cartilage .


Schematic image of the hypoglossal nerve and innervation targets.


An injured hypoglossal nerve will cause the tongue to  waste away  and the tongue will not be able to stick out straight. The injury here occurred because of  branchial cyst  surgery.  [ 18 ]


Inferior nasal concha - animation 02


Right and left inferior nasal conchae


The four compartents of the right masticator space.  A  Temporalis muscle,  B  Masseter muscle,  C  Lateral pterygoid muscle,  D  Medial ptaerygoid muscle,  E  Superficial temporal space,  F  Deep temporal space,  G  Submasseteric space,  H  Pterygomandibular space,  I  Approximate location of infratemporal space.


Inner ear


The  cochlea  and  vestibule , viewed from above.


A cross-section of the  cochlea  showing the  organ of Corti .


Cross-section through the spiral organ of Corti at greater magnification.


Internal carotid artery


Segments of the internal carotid artery, delineated on an  MRA  of the head.


Level of 6th cervical vertebrae - still at level of common carotid but relationships are similar to those of cervical segment of internal carotid


Internal carotid artery - dissection


Oblique section through the cavernous sinus.


The ophthalmic artery and its branches


Depicts nerve branches that are involved in the autonomic innervation of the lacrimal gland. The terminal parts of the pathway are variable between individuals and differ for the other glands of the deep face.


Laryngitis


A laryngology exam and procedure room.


Mandibular prognathism


Anatomical landmarks of the mandible from a right lateral view


External oblique line of the mandible (shown in red)


Mandibular first molar teeth (shown in red)


Inter-maxillary fixation of the mandible


Mastoid cells


Mastoid process shown in red


"De Sanitate tuenda", Galen, 1517 Wellcome L0003071


The Surgeon , engraving by Lucas van Leyden, 1524, depicting a barber surgeon making an incision


Hermann Schwartze


Mastoiditis with subperiostal abscess


Mastoid cells  of Lenoir


CT scan :  Otitis media  (simple arrow) and mastoiditis (double arrow) of the right side (left side in image). The  external auditory canal  is partially occupied by suppuration (triple arrow). 44-year-old woman.


Attack triangle in mastoidectomies


Inferior surface of maxilla


Anterior surface of maxilla at birth


Inferior surface of maxilla at birth


Fracture of the left lacrimal / maxillary bone


The maxillary sinus can normally be seen above the level of the premolar and molar teeth in the  upper jaw .  This  dental x-ray film  shows how, in the absence of the second premolar and first molar, the sinus became  pneumatized  and expanded towards the crest of the alveolar process (location at which the bone meets the gum tissue).


CT Brain showing air-fluid level in bilateral maxillary air sinuses post brain trauma. Maxillary sinusitis will also shows similar air-fluid collection and should be rule out from history taking.


Inner ear


Audiograms  illustrating normal hearing (left) and unilateral low-pitch hearing loss associated with Ménière's disease (right)


Loudness discomfort levels (LDLs) – data of people with hyperacusis without hearing loss. Upper line: average hearing thresholds. Lower long line: LDLs of this group. Lower short line: LDLs of a reference group with normal hearing. [ 15 ]


A podiatrist prepares for microsurgery.


The middle ear matches mechanical impedance, like a lever.


Retracted eardrum


Side view of the cartilages in the nose.


Right side view of the septal nasal cartilage.


Major alar and minor alar cartilages, seen from below.


External incision used during a rhinoplasty.


U.S. Air Force Maj. Brent Feldt, performing a septoplasty.


Patient with metal split after a rhinoplastic procedure.


Nasal cavity anatomy


CT scan  in the  coronal plane , showing the ostiomeatal complex (green area)


Coronal section of nasal cavity


Paranasal sinuses : 1. frontal sinuses, 2. ethmoid sinuses (ethmoidal air cells), 3. sphenoid sinuses, 4. maxillary sinuses


Nasal polyp appearing in the middle meatus.


Histology of nasal polyp, magnification 25x ( H&E stain )


Professor Heinz Stammberger, known as the father of endoscopic sinus surgery, teaching the technique at Tarabichi Stammberger Ear and Sinus Institute.


CT scan images after application of radioactive laced nasal steroids using long nozzle. Note the reach of the medication into the area where nasal polyps originate


Vomer  of infant


Modified radical neck dissection


Two children  boxing , the one on the right having a nosebleed due to a punch to the face, in  Vecsés ,  Hungary  in November 2006


The arteries that supply Kiesselbach's plexus (responsible for anterior nosebleeds)


Coronal image of  mouse  main olfactory bulb cell nuclei. Blue  – Glomerular layer;  Red  – External Plexiform and  Mitral cell  layer; Green  – Internal Plexiform and  Granule cell  layer. Top of image is  dorsal  aspect, right of image is  lateral  aspect.  Scale, ventral to dorsal, is approximately 2mm.


Flow of olfactory information from receptors to glomeruli layer


Fossil  endocast  of a  Tyrannosaurus  cranial vault, showing extensive olfactory bulb (structure to the left). Tyrannosaur dinosaurs, as well as carnivorous animals in general, have highly developed olfactory bulbs to seek out prey.


A schematic drawing of the components of the embryonic olfactory epithelium. ORN =  olfactory receptor neuron , OEC =  olfactory ensheathing cell


Embryonic morphogen signaling on olfactory placode and neural crest cells contributes to formation of neurogenic and non-neurogenic tissue of the olfactory epithelium.


Olfactory sensory neurons (OSNs) express odorant receptors. The axons of OSNs expressing the same odorant receptors converge onto the same glomerulus at the olfactory bulb, allowing for the organization of olfactory information.


A  fundus photograph  showing the back of the retina. The white circle is the beginning of the optic nerve.


Oropharyngeal cancer (from right tonsil, HPV-negative), T4a N2c, 48-year-old man.


Types of oropharyngeal cancer and associated survival rates


Swelling of the right neck from the spread of oral cancer.


Ulceration on the left lower lip caused by cancer


Stall selling betel quid


Oral  leukoplakia  (white patch) on the left tongue. Proven to be severe dysplasia on biopsy


A large squamous cell carcinoma of the tongue as seen on CT imaging


Histopathologic appearance of a poorly differentiated squamous cell carcinoma specimen. Hematoxylin-eosin stain. p16 positive, EBV negative


Spread of cancer beyond the capsule of a lymph node (ENE+).


Post-operative image after removal of oral cancer with part of the  mandible  ( feeding tube  in nose)


Common scar line after cervical lymph node dissection


Radiation treatment


Deaths from mouth and oropharynx cancers per million people in 2012     0–8    9–11    12–15    16–18    19–24    25–31    32–40    41–55    56–75    76–156


A beagle with oral cancer.


3D model of orbit with surrounding bones


The seven bones that form the orbit: yellow =  Frontal bone green =  Lacrimal bone brown =  Ethmoid bone blue =  Zygomatic bone purple =  Maxillary bone aqua =  Palatine bone red =  Sphenoid bone teal =  Nasal bone  (illustrated but not part of the orbit)


Tear system : a. tear gland / lacrimal gland, b. superior lacrimal punctum, c. superior lacrimal canal, d. tear sac / lacrimal sac, e. inferior lacrimal punctum, f. inferior lacrimal canal, g. nasolacrimal canal


Anatomy of the three ossicles


Otitis media


Perforation of the right tympanic membrane resulting from previous severe acute otitis media


Disability-adjusted life year  for otitis media per 100,000 inhabitants in 2004.             no data      < 10      10–14      14–18      18–22      22–26      26–30          30–34      34–38      38–42      42–46      46–50      > 50


Deaths from otitis media per million persons in 2012     0    1    2–4


Thieme  Synthesis: [ 5 ]  Patent: [ 6 ]  Sino: [ 7 ]  Precursor patent: [ 8 ]


Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top). Stratified  epithelium  (e) covers the throat's surface and continues as a lining of the crypt. Beneath the surface are numerous nodules (f) of  lymphoid  tissue. Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the  saliva  as salivary corpuscles (s).


A medical animation still that shows tonsillitis


Paranasal sinuses


Smoking is strongly related to paranasal sinus and nasal cavity cancer


The parotid gland


Relative incidence of parotid tumors. [ 16 ]


Surgical planning using  bone segment navigation  for the  osteotomy  of the jaw bones, based on models fixed into an  articulator  (registration based on infrared devices)


Schematic representation of the SSN system


Actual usage of the SSN system in the operating room


Normal ear drum


Peritonsillar abscess on the person's right as seen on CT imaging


Posterior borders of the petrous part of the temporal bone in the  posterior cranial fossa  shown at (2) in blue


A normal throat


Exudative  pharyngitis in a person with  infectious mononucleosis


A case of strep throat


Throat swab


Upper respiratory system, with the nasopharynx, oropharynx and laryngopharynx labeled at left


Details of  torus tubarius


Pharyngitis is the painful swelling of the throat. The oropharynx shown here is very inflamed and red.


An illustration of the pharyngeal jaws of a moray eel


US Navy 090704-A-0566T-023 Operation Smile staff member Dr. Hal Rosenfeild begins reconstructive surgery for a cleft lip on a three-month-old infant aboard the Military Sealift Command hospital ship USNS Comfort (T-AH 20)


Pathological changes in non-allergic rhinitis [ 26 ]


Mechanism of non-allergic rhinitis: Imbalance between sympathetic and parasympathetic components in the nasal mucous membrane [ 26 ]


Sublabial incision through which  periosteum  of  maxilla  is elevated in an endoscopic midface lift (rhytidectomy).


The difference between an aged eye and a youthful eye, looking at the distance from the cilliary margin to the inferior-most point of the orbicularis oculi muscle.


A. Increased redundancy of the nasolabial fold (caused by a descent of cheek fat)  B. Increased distance from the ciliary margin to the inferior-most point of the orbicularis oculi muscle (caused by decreasing tone of the orbicularis oculi muscle)  C. Jowl (a broken jaw line by ptosis of the platysma muscle)  D. The intended effect of a facelift


The technique of a SMAS facelift, consisting of mobilisation, repositioning and fixating.


Blue represents the incisions in the Skin only facelift. Green represents the S-lift. Red is the extensive undermining done in several facelift techniques.


Cochlea and vestibular system


The Lady and the Unicorn , a Flemish tapestry depicting the sense of smell, 1484–1500.  Musée national du Moyen Âge , Paris.


Schematic of the early olfactory system including the olfactory epithelium and bulb. Each ORN expresses one OR that responds to different odorants. Odorant molecules bind to ORs on cilia. ORs activate ORNs that transduce the input signal into action potentials. In general, glomeruli receive input from ORs of one specific type and connect to the principal neurons of the OB, mitral and tufted cells (MT cells).


Pieces removed from nasal cavities during septoplasty


Screenshot of a PSG system showing an obstructive apnea


No airway obstruction during sleep


Airway obstruction during sleep


Screenshot of a PSG system showing a central apnea


Person using a CPAP mask, covering only the nose


CPAP device on a nightstand


Illustration of surgery on the mouth and throat


Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.


Seven bones articulate to form the  orbit . The sphenoid bone is in red (directly in the middle of the  orbital cavity )


Wedge-shaped sphenoid bone seen laterally


Figure 4 :  Sphenoid bone at birth, posterior aspect.


Paranasal sinuses


The size of the  stapes , compared with a 10-cent  euro  coin.


The  stapes , as first described by  Giovanni Filippo Ingrassia   (Labeled M, bottom right) .


Sternocleidomastoid labelled


The sternocleidomastoid muscle with nearby structures labeled, such as the  triangles of the neck .


Drawing of an open mouth showing the frenulum linguae and surrounding structures


Diagram of medial surface of the mandible, showing the slanting attachment of mylohyoid (the mylohyoid line). This arrangement means that the apices of posterior teeth are more likely to be below the level of mylohyoid, so a  periapical abscess  associated with posterior teeth is more likely to spread into the  submandibular space .


Diagram showing sublingual gland in sublingual space


Sublingual caruncles highlighted on either side of the  lingual frenulum


Human submandibular gland. At the right is a group of mucous  acini , at the left a group of serous acini.


Parasympathetic and Sympathetic connections of the submaxillary and superior cervical ganglia.


Relative incidence of submandibular tumors. [ 15 ]


Diagram of medial surface of the mandible, showing the slanting attachment of mylohyoid (the mylohyoid line). This arrangement means that the apices of posterior teeth are more likely to be below the level of mylohyoid.


Left submandibular space (right side shown with digastric muscle removed).


Cricothyrotomy kit


The diagram (a), (b), (c) show different positions of vocal cords in different conditions.


A piece of thyroid cartilage is cut and pushed towards the medial side by placing an implant.


In this type of implant system, the thyroid cartilage is pushed towards the medial side using the silastic implant.


Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top). Stratified  epithelium  (e) covers the throat's surface and continues as a lining of the crypt. Beneath the surface are numerous nodules (f) of  lymphoid  tissue. Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the  saliva  as salivary corpuscles (s).


CT scan  of tonsilloliths


General size of a tonsilolith compared to a finger


Cryptic tonsils immediately following surgical removal (bilateral tonsillectomy).


Throat 1 day after a tonsillectomy.


Throat some days after a tonsillectomy.


Tonsil guillotine.


Illustration comparing normal tonsil anatomy and tonsillitis


Bacteria or viruses can cause tonsillitis.


Throat swab


Laryngoscope handles with an assortment of Miller blades (large adult, small adult, child, infant and newborn)


Laryngoscope handle with an assortment of  Macintosh  blades (large adult, small adult, child, infant and newborn)


Laryngoscopy


An endotracheal tube stylet, useful in facilitating orotracheal intubation


A cuffed endotracheal tube, constructed of  polyvinyl chloride


A Carlens double-lumen endotracheal tube, used for  thoracic surgical  operations such as  VATS lobectomy


An endotracheal tube in good position on CXR. Arrow marks the tip.


An endotracheal tube not deep enough. Arrow marks the tip.


Laryngoscopes prepared for emergency anaesthesia


In cricothyrotomy, the incision or puncture is made through the  cricothyroid membrane  in between the  thyroid cartilage  and the  cricoid cartilage


Cricothyrotomy  kit


Diagram of a  tracheostomy tube  in the trachea:  1 -  Vocal folds  2 -  Thyroid cartilage  3 -  Cricoid cartilage  4 -  Tracheal rings  5 - Balloon cuff


A  premature infant  weighing 990 grams (35 ounces), intubated and requiring  mechanical ventilation  in the  neonatal intensive-care unit


Tracheal intubation is anticipated to be difficult in this child with a massive  ameloblastoma


The laryngoscopy. From  García , 1884


Figure A shows a side view of the neck and the correct placement of a tracheostomy tube in the trachea, or windpipe. Figure B shows an external view of a patient who has a tracheostomy.


Tracheotomy tubes and  endotracheal tubes  are often attached to  ventilators  to assist in breathing.


An outer cannula (top item) with inflatable cuff (top right), an inner cannula (center item) and an obturator (bottom item)


A tracheostomy from prior to the 20th century


Hieronymus Fabricius  (1533–1619) was the first to introduce the idea of a tracheostomy tube


Laryngeal structures, trachea (1–4) and invasive procedures (A–B) (1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy (B) Tracheotomy


Dermatome  distribution of the trigeminal nerve


Dermatome distribution of the trigeminal nerve


C = Cervical segment, S = Sacral segment, VPL =  Ventral posterolateral nucleus , SI =  Primary somatosensory cortex , VM =  Ventromedial prefrontal cortex , MD =  Medial dorsal thalamic nucleus , IL =  Intralaminar nucleus , VPM =  Ventral posteromedial nucleus , Main V =  Main trigeminal nucleus , Spinal V =  Spinal trigeminal nucleus


Brainstem nuclei: Red = Motor; Blue = Sensory; Dark blue = Trigeminal nucleus


Onion-skin distribution of the trigeminal nerve


Cortical homunculus


Tympanostomy tubes of varying size and shape. Examples of short-term use grommet (left) and long-term use T-shape (right).


Tympanostomy tube in the eardrum, draining fluid from the middle ear during an ear infection.


Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.


Open vocal cords as seen during normal inhalation


Closed vocal cords as seen during a VCD episode (or when speaking)


Vocal folds (open)


Vocal folds (speaking)


The vocal folds in motion


Diagram depicting mouth acidity changes after consuming food high in  carbohydrates . Within 5 minutes the acidity in the mouth increases as the pH drops. In persons with normal salivary flow rate, acid will be neutralized in about 20 minutes. People with dry mouth often will take twice as long to neutralize mouth acid, leaving them at higher risk of tooth decay and acid erosion


A painting of  Zeus  emasculating  Cronus ,  c.  1501


An emasculated Chinese eunuch from the Qing dynasty


Emasculated Skoptsy male (left) and Skoptsy female with breasts cut off (right)


Inguinal orchiectomy being performed


Genital area of male after partial penectomy


Circumcised penis with frenulectomy (ventral view) (circumcision procedure at birth)


Comparison of penile implants (inflated cylinder diameter and length)


Penile implant pump design comparison


A diagram of an inflatable penile implant inserted into corpus cavernosum of the penis


Evoking an erection with an implanted penile implant


An inflatable penile implant inserted into corpus cavernosum of the penis


Hip showing scar from skin graft used for phalloplasty.


Example of stage 1  female-to-male sex reassignment  prior to glansplasty penis with tissue grafting scar on the left hip


Preputioplasty Fig 1. Penis with tight  phimotic ring  making it difficult to retract the foreskin. Fig 2. Foreskin retracted under anaesthetic with the phimotic ring or  stenosis  constricting the shaft of the penis and creating a "waist". Fig 3. Incision closed laterally. Fig 4. Penis with the loosened foreskin replaced over the glans.


Prostate-specific antigen


Global comparisons of prostate cancer screening


Prostate and nearby organs


Prostate Removal


Diagram showing before and after a radical prostatectomy


Muscles of the male perineum


Prostate location


Human male reproductive system


A modified scrotoplasty for penoscrotal webbing in children


Post-traumatic leakage of sperm provoking a granulomatous reaction.


Urologist with a rigid cystoscope inserted into the urethra


Open-ended vasectomy


Haematoma on penis and scrotum 24 hours after microsurgical vasovasostomy


Appearance of a blepharoplasty on an adult male one day after surgery


Incision lines for blepharoplasty


Transconjunctival blepharoplasty: The removal of orbital fat for the cosmetic modification of the lower eyelid [ 8 ]


Initial incision along the upper left eyelid


Blepharoplasty: The yellow fat (adipose tissue) and the skin (linear tissue) removed during a quadruple blepharoplasty. The fat from the lower eyelid was removed with a transconjunctival technique.


Anesthetizing the lateral canthus


Cutting lateral canthus


Conformer over eye implant post-enucleation


Removed  corneal epithelium  during CCR operation on an eye with post- LASIK  complication, from Kymionis et al., 2009 [ 6 ]


Cornea transplant one day after surgery.


Cornea transplant after one year of healing, two stitches are visible


Replacement of the entire cornea


Boston Kpro type 1 titanium posterior plate


Eduard Zirm


Spanish-born eye surgeon  Ramón Castroviejo  successfully performed keratoplasty as early as 1936.


"Couching for cataract";  Wellcome Collection  illustration of Indian doctors performing the technique.


Cyclocryotherapy (frozen spot visible)


Fig 3: Animation showing glued IOL surgery. Note the flaps made on the white portion of the eye (sclera). The IOL is injected inside the eye and one end (haptic) is grasped with the glued IOL forceps


Fig 4: Glued IOL surgery. The IOL is inside the eye. Both the haptics (blue color) are externalized under the scleral flaps. They will be tucked into scleral pockets and fibrin glue applied to seal them


Fig 5 : A-A three piece IOL above the rhexis is still subluxated. B-Scleral flaps are made 180 degrees apart. One hand holding the ahptic with the glued IOL forceps while the other is doing vitrectomy. The capsule remnants are removed as they are not needed for the glued IOL. C-Handshake technique being done to catch the tip of the haptic. Notice the trocar cannula on the upper right. One needs fluid in the eye always. An AC maintainer also be used instead. D-One haptic externalized.


Fig 6 : Subluxated three piece IOL glued into place- Part 2. A- Second haptic is caught with the handshake technique. B- Both haptics externalized. C- Both haptics tucked in scleral pocket. D- Air in the AC, Fluid is switched off and glue applied. The air prevents any hypotony.


Fig 7A : Case with aniridia (no iris) glaucoma (increased pressure in the eye) and subluxated cataract.


Fig 7B : Cataract removed, anti glaucoma surgery done and an aniridic glued IOL fixed which has artificial iris and IOL.


Fig 8 : Pre-Descemets Endothelial Keratoplasty – the latest technique of corneal eye transplantation photograph of a patient with corneal haziness due to endothelial damage with lens displaced before surgery (left) and the same patient after 6 months of PDEK with glued IOL surgery (Right). Note the white cornea is becoming clear (right). (Below) Anterior segment optical coherence tomography scan showing good adhesion of the graft on the inner side of cornea.


Cataract surgery, using a temporal approach phacoemulsification probe (in right hand) and "chopper" (in left hand)


"Couching for cataract";  Wellcome Collection  illustration of Indian doctors performing couching.


Beer-type cataract knife and needle, cased, Paris, 1820-1866


A cataract surgery.  Dictionnaire Universel de Médecine  (1746–1748)


Fig 2 : GLUED IOL SCAFFOLD  A- Cataract piece lying inside the eye (creamy white color). The Intraocular lens (IOL) is injected inside the eye.  B- Handshake technique done to externalize the haptics of the IOL.  C- Handshake technique completed.  D- Both haptics of the IOL are externalized. The IOL is under the cataract piece and acts as a scaffold preventing the cataract pieces from falling down.  E- The phaco handpiece emulsifies the cataract pieces using ultrasound. The glued IOl is acting as a scaffold so the technique is called glued IOL scaffold  F- Cataract pieces removed.


Fig 3 : GLUED IOL SCAFFOLD FOR SOMMERING RING  A: Two scleral flaps are made diagonally apart.B: IOL injected below the Sommering ring (thick white portion) and IOL haptics externalized similar to glued IOL.C: Sommering ring dislodged and positioned on the IOL.  D: Sommering ring removed by phaco handpiece.


Fig 4 : IOL SCAFFOLD FOR INTRAOCULAR FOREIGN BODY (IOFB) REMOVAL.  A: IOFB retrieved from the posterior part of eye and placed on the iris.B: IOL injected on the remaining lens bag.C: IOFB removed via the corneal wound over the IOL.


An anatomical diagram of the human eye, showing vitreous humor in the vitreous chamber.


A photo of a right eye divided into 4 quadrants: superotemporal, superonasal, inferotemporal, and inferonasal.


An anatomical diagram showing the limbus of the eye.


Ancient Hindu and modern iridectomy knives


Fig 1 : Photograph shows the normal layers of the cornea from front to back (Epithelium, Bowman's layer, Stroma, Predescemet's layer, Descemet's membrane and Endothelium).


Fig 2 : Pre-Descemet's endothelial keratoplasty (PDEK). A, B: A 30 gauge needle is introduced into the centre of the cornea and air is injected.  A big bubble is formed in the donor cornea on the endothelial side and it is pierced with Knife. C, D: Graft is stained or coloured by Trypan blue dye and dissected out.


Fig 3 : Graft injection into the host bed in combined PDEK with glued IOL. A: A central Big bubble formed in the donor cornea by pushing air into the cornea B,C: Flaps are made in the white sclera, IOL is inserted into the eye and the arms or haptics of the IOL is pulled out of the eye and attached to the white sclera in a tunnel and then glue is applied. The patient's damaged posterior part of cornea (descemet's membrane with endothelium) peeled manually. D: PDEK graft pushed into the eye under saline and opened. Endoilluminator or external light source is used to confirm the orientation of the graft. E, F: Donor graft is attached to the host stroma by air injection below the graft without sutures.


Fig 4 : Pre Descemets Endothelial Keratoplasty - the latest technique of corneal eye transplantation Photograph of a patient with corneal haziness due to endothelial damage with lens displaced before surgery (left) and the same patient after 6 months of PDEK with glued IOL surgery (Right). Note the white cornea is becoming clear (right). (Below) Anterior segment optical coherence tomography scan showing good adhesion of the graft on the inner side of cornea.


Fig 5 : Pre Descemets Endothelial Keratoplasty in young donor. In this 25 micron from a young or infant donor eye is transplanted into an adult and makes the adult eye see. On the left note the adult eye before Pre Descemets Endothelial Keratoplasty surgery . The eye is white and patient cannot see. On the right is same patient after Pre Descemets Endothelial Keratoplasty surgery using a young donors 25 micron corneal tissue . Note the clear eye and patient can see the last line on the vision testing.


Small pterygium


Large primary pterygium invading the pupil (visual axis)


Micrograph  of a  conjunctiva  associated with prominent blood vessels (left-bottom of image) and elastotic collagen (centre of image), as may be seen in a pterygium.  H&E stain .


Pterygium removal surgery


Disinserting the medial rectus muscle


The superior oblique muscle (black arrow) and the inferior oblique muscle (blue arrow) are highlighted in this depiction of a human right eye from the anterior perspective.


Single port 19-gauge vitrectomy


Vitrectomy instruments


A wristband that provides a warning regarding risks post vitrectomy


Showing eyes shortly after vitrectomy and removal of bandages


Trepanned skull from  Edinburgh


World Academy of Neurological Surgery's conference


Histopathology  specimen of  Angiocentric glioma , higher magnification, HE stain


The location of the amygdala in the human brain


The stereotaxic apparatus used for clinical amygdalotomy


The  trigeminal nerve .


Diagram of cerebral aneurysm.


The most common sites of intracranial saccular aneurysms


CT angiography showing aneurysm measuring 2.6 mm in diameter at the ACOM (anterior communicating artery).


A selection of  Mayfield  and  Drake  aneurysm clips ready for implantation.


Here is the arm of the ROSA One


Illustration depicting a surgical discectomy


Spinal reflections and folds


Resected middle cerebral artery aneurysm filled with multiple coils.


A 3D reconstruction of the  Circle of Willis  derived from a CT angiogram.


Spinal surgeons operating on a patient's back


CT scan showing markedly thickened  ligamentum flavum  (yellow ligament) causing  spinal stenosis  in the lumbar spine.


CT scan image of large herniated disc in the lumbar spine.


CT scan of laminectomy showing scar formation (highlighted in red)causing new stenosis.


Myelogram  showing typical findings of arachnoiditis in the lumbar spine.


CT scan showing post operative scarring and arachnoiditis.


CT scan showing two views of L4-5 disc herniation


Ultrasound of the optic nerve showing IIH [ 17 ]


A  lumbar puncture  in progress. A large area on the back has been washed with an  iodine -based disinfectant leaving brown colouration. In this image the person is seated upright, which can make the procedure easier to perform but makes any measurement of the opening pressure unreliable.


The number of new cases per year of IIH is strongly determined by sex and  body weight . The figures in females are in women between 20 and 45 years old. [ 5 ]


Graphic of lumbar laminectomy and two conditions it can address.


Human Vertebral Column


Vertebra Superior View


Vertebral Column: Lamina


US Navy Cmdr. Kenneth Kubis, director of surgical services aboard the Military Sealift Command hospital ship USNS Mercy uses an operating microscope


Featured: Ligamentum Flavum


MRI of the lumbar spine showing spinal stenosis


Advertisement for a Leucotome in the 1940s


A leucotome designed by Neurosurgeon John Crumbie,  Croydon Mental Hospital , 1955 [ 3 ]


NF-2 may be inherited in an  autosomal dominant  fashion, as well as through random mutation.


Micrograph  of a  schwannoma , a tumor seen in neurofibromatosis type II.  HPS stain .


Schwannoma of the N. Vestibularis


Meningiomas in a person with NFII


NF-2 Locus


Photo of Mathieu Jaboulay courtesy of Romain Rochefeuille


Magnetic Resonance Image of Lumbar Spine courtesy of Nevit Dilmen


Nerve block of cervical spine courtesy of PainDoctorUSA


Left Dorsolateral Prefrontal Cortex targeted using high definition MRI. The red sphere is the anterior inferior left DLPFC, the green sphere is the indicated coil location. Left DLPFC is stimulated for the treatment of depression and other conditions


3d printed transcranial magnetiс stimulation patient-specific guide based on MRI data capable to hold 2 Magventure MCF-B65 coils in selected regions on both frontal lobes.


CAD model of patient-specific TMS guide


1) Boron compound (b) is selectively absorbed by cancer cell(s). 2) Neutron beam (n) is aimed at cancer site. 3) Boron absorbs neutron. 4) Boron disintegrates emitting cancer-killing radiation.


Skull of the  tuatara  ( Sphenodon punctatus ), with the pineal foramen enclosed by the parietal bones


Micrograph  showing a primary CNS lymphoma with the characteristic perivascular distribution composed of large cells with prominent  nucleoli .  Brain biopsy .  HPS stain .


Planning  CT scan  with IV contrast in a patient with left cerebellopontine angle  vestibular schwannoma


A doctor performing Gamma Knife Radiosurgery


NRC  graphic of the Leksell Gamma Knife


Frame for Stereotactic Thalamotomy on display at the  Glenside Museum


Jorge Candia, Antonio Martos and Jorge Olivetti


The first surgery performed with Latin-American system was a Trigeminal Nucleotractothomy, performed by Jorge Schvartz.


Part of a stereotaxic atlas showing the human thalamus and nuclei


Circle of Willis with the most common locations of ruptured aneurysms marked


A  lumbar puncture  in progress. A large area on the back has been washed with an  iodine -based disinfectant, leaving brown coloration.


Xanthochromia  versus normal CSF


ECG changes resembling those of an STEMI in a woman who had an acute CNS injury from a subarachnoid hemorrhage


Arteriogram  showing a partially coiled aneurysm ( indicated by yellow arrows ) of the  posterior cerebral artery  with a residual aneurysmal sac. The person was a 34-year-old woman initially treated for a subarachnoid hemorrhage.


Autopsy  of a case with subarachnoid hemorrhage. The arachnoid mater is left in place on the exterior surface, containing extensive hemorrhage that also fills the sulci, as detailed in magnified image.


Average number of people with SAH per 100,000 person-years, broken down by age [ 90 ]


The picture shows three exemplary steps during white matter dissection. In the upper part, a left hemisphere has been prepared according to Klingler's technique. The arachnoidal layer and the blood vessels were previously removed. In the middle part of the picture the first step of white matter dissection with the exposure of short fibres (U-fibres) which are visible underneath the cerebral cortex. In the lower part, a deeper layer of anatomical dissection with white matter structures (associative and projection fibres) and basal ganglia (Putamen). [ 1 ]


Plates vi & vii of the Edwin Smith Papyrus at the Rare Book Room,  New York Academy of Medicine [ 7 ]


The Roman scholar  Aulus Cornelius Celsus  recorded surgical techniques, including plastic surgery, in the 1st century AD.


A statue of  Sushruta , at the  Royal Australasian College of Surgeons  in  Melbourne , Australia


Illustration of an 18th-century nose reconstruction method from Poona performed by an Indian potter, from  The Gentleman's Magazine , 1794


Johann Friedrich Dieffenbach  established many modern techniques of  reconstructive surgery .


Walter Yeo , a sailor injured at the  Battle of Jutland , is assumed to have received plastic surgery in 1917. The photograph shows him immediately following (right) the  flap surgery  by  Sir   Harold Gillies , and after healing (left). [ citation needed ]


Alloplastic bone packed into socket for maxillary canine, then covered with gingival graft


Plateau-root form dental implants of 3 different sizes


Implant creation sequence: CT scan to CAD to 3D printed titanium cranial implant


Mock up of artificial shoulder implant that remained in a patient for two years, until removed due to infection.


Fractured implant and abutment screw in tooth socket


An anaplastologist fits an  Iraq War  veteran with  prosthetic ears


Botulinum toxin being injected in the human face


Target molecules of botulinum neurotoxin (abbreviated  BoNT ) and  tetanus neurotoxin  ( TeNT ), toxins acting inside the axon terminal [ 90 ]


Doctor performing Botulinum toxin injection


Cheek reduction:  Bilateral extraction of buccal fat, assisted with lipoinjection to the bilateral malar eminences.


Grade IV capsular contracture in the right breast of a 29 y.o. woman, seven years after subglandular placement of 560cc silicone gel-filled  breast implants .


Image taken after a capsular contracture scar tissue removal surgery, showing the removed implant and removed tissue capsule. [ 13 ]


Pudendum femininum:  The external anatomy of the vulvo-vaginal complex, indicating the clitoris, the clitoral prepuce, the labia majora, and the labia minora.


A doctor performing Microdermabrasion cosmetic skin procedure for  removal of dead skin, also known as skin polishing.


Diagram of a dermatome


Side view of a drum dermatome blade (24) removing a slice of skin (38 and 40).


a)  Fasciotomy  and b)  Escharotomy  in a child with third degree burns. A motorized  dermatome  is used to make the incisons.


Patient with cryolipolysis applicator


The distribution of the blood vessels in the skin of the  sole of the foot . The  dermis  is referred to as  corium .


Breast reconstruction using the latissimus dorsi muscle and an implant. This is an example of a pedicled musculocutaneous flap.


Walter Yeo , before (left) and after (right) skin flap surgery performed by  Harold Gillies  in 1917.


Stages of non-surgical restoration


A partially restored foreskin after four years of  non-surgical restoration


(left) Circumcised, (middle) restored foreskin, (right) uncircumcised


Anterior view of major and minor (lighter color)  body hair  growth areas in anatomically typical females and males.


Vintage advert for the Milady Décolleté Gillette women's safety razor – 1916


Leg shaving  using a  razor


Very pronounced upper body hair growth, probably  hypertrichosis , on an adult male.


Typical habitat with a large population, Germany


Treating  mastitis  of a cattle with leech


A  caricature  of a physician prescribing leeches for a weak, bedbound woman


Earthenware jar for holding medicinal leeches


The individual size, coloration and shapes of the labia minora are subject to significant variability between women. The labia minora are completely covered by the labia majora in some women in a standing posture, while in others they protrude visibly from the pubic cleft.


Protest march in London opposing cosmetic labiaplasty surgery


A hair removal laser in 2011


Laser hair removal can be used to treat  pseudofolliculitis , common in men who have naturally coarse or tightly curling thick facial hair. [ 8 ] [ 9 ]


A hair removal laser in 2021


A woman showing typical lip augmentation


Lip lift:  the post-operative aspect (left), and the pre-operative aspect (right) of surgically modified lips. The Vermilion border is noticeably more defined in post-operative aspect.


Lip lift: the pre-operative aspect (left), and the post-operative aspect of the lifted corners of the mouth.


Liposuction aspirate


An illustration for the origin of the term


Figure 1. Example of a paramedian forehead flap design


Figure 2. The nasal defect after adjustment to the aesthetical subunits


Figure 3. The full-thickness forehead flap is sutured into the recipient site during stage one


Figure 4. The result after stage 1, without initial thinning of the flap


Figure 5. Situation before the second stage of reconstruction


Figure 6. Elevation and thinning of the flap during stage 2


Figure 7. The healed excess soft tissue and cartilage have been sculpted to improve contour


Figure 8. The thinned forehead skin is returned to the contoured recipient


Figure 9. The result after a three-stage forehead flap


Negative pressure wound therapy device


Pump used to create negative pressure


An example of a vacuum bandage


Negative pressure system used in a surgical wound in the right knee and thigh. The little vacuum pump is shown on the left of the photo, as is a subcutaneous drain.


The German polymath Johann Friedrich Dieffenbach was a pioneer in the fields of plastic surgery. ( c.  1840 )


The auricle is an anatomic structure composed of a cartilage support framework covered with thin, hairless skin.


Prominent ears: the bat-wing type, which extend outwards and to the front, can be corrected with an otopexy procedure.


The angles of the ear  determine the surgical anatomy of the auricle, as considered for otoplasty correction.


Auricular prominence: in the occipital area, behind the auricle, a protruding mastoid process is a proximate cause of bat ears.


The soft tissues of the ear: the anatomic location of the posterior muscle of the ear (auricularis posterior) in relation to the auricle.


Otoplasty: The cranial surface cartilage of the right ear; the ponticulus (center right) and the cauda helicis (right) also can be proximate causes of prominent ears.


The soft tissues of the right ear: the three muscles that serve the auricle (external ear) the auricularis posterior (left), the auricularis superior (above), and the auricularis anterior (right) as considered for otoplasty correction.


Ear showing Darwin's tubercle, an evolutionary human-ear vestige in a woman, and the like morphologic feature in a macaque monkey.


Grade III microtia affecting the left ear of a boy.


Non-surgical otoplasty: the therapeutic aspects, before (left), during (center), and after (right), of a tissue-molding procedure performed with an EarWell device.


Direct and indirect perforators


Propeller flap


Permanent makeup: before, immediately after, and healed – brow, eyeliner, and lip procedures


Dark Passage 1947 Lobby Card 1


Plates vi & vii of the  Edwin Smith Papyrus  at the  Rare Book Room ,  New York Academy of Medicine [ 3 ]


Artificial nose, made of plated metal, 17th–18th century Europe. This would have been worn as an alternative to rhinoplasty.


Nasal anatomy: Squamous epithelium is one of several types of epithelia.


Nasal anatomy: The procerus muscle (musculus procerus, pyramidalis nasi, depressor glabellae).


Rhinoplasty: the surgical nose as aesthetic nasal segments.


Rhinoplasty: The common carotid artery.


Nasal innervation: Cranial nerve V, the trigeminal nerve (nervus trigeminis) gives sensation to the nose, the face, and the upper jaw (maxilla).


Nasal innervation: Cranial nerve VII (nervus facialis) is the facial nerve that gives sensation to the nose and the upper jaw (maxilla).


Nasal anatomy: The shell-form turbinates (conchae nasales).


Nasal anatomy: The  septum nasi  bones and cartilages.


Rhinoplasty. Nasal anatomy: The philtrum.


Rhinoplastic correction: A child affected by a cleft lip and a cleft palate.


Rhinoplasty: In relation to the  nasal bone  (teal green), seven bones compose the orbit: (1) the  frontal bone  (yellow)  (2) the  lacrimal bone  (green)   (3) the  ethmoid bone  (brown)   (4) the  zygomatic bone  (blue)   (5) the upper jaw  maxillary bone  (purple)   (6) the  palatine bone  (aqua)   (7) the  sphenoid bone  (red)


Photograph 2. Open rhinoplasty: The right lower lateral cartilage (blue) is exposed for correction.


Photograph 1. Open rhinoplasty: The columellar incision delineated as a red-dot guideline, will assist the surgeon in the precise suturing of the nose.


Photograph 4. Rhinoplastic correction: A nasal-hump excision plan; the black line delineates the dorsal plane of the new nose.


Photograph 3. Open rhinoplasty: the nasal tip is sutured to narrow the nose.


Rhinoplasty: Right lateral view of the  nasal cartilages  and the nasal bone.


Rhinoplasty: Lateral wall of the nasal cavity.


Rhinoplasty: A  melanoma  lesion, a type of  skin cancer  that occurs to the nasal skin.


Rhinoplasty: The nasal muscle compresses the nasal bridge, depresses the tip of the nose, and flares (elevates) the corners of the nostrils.


Rhinoplasty: A paramedian forehead flap design


Rhinoplasty: A basal-cell carcinoma lesion on the juncture of the left alar base subunit and the left dorsal sidewall subunit, i.e. on the left nostril.


Rhinoplasty: A divided section design used in Mohs surgery for excising cancerous lesions before nasal reconstruction.


Revision rhinoplasty: The American actor W.C. Fields was affected by rhinophyma.


Illustration 2: Nose-narrowing rhinoplasty; two chisel cuts (green and black arrows) meet at the red zig-zag line to release the bone for corrective re-alignment.


Illustration 1: The nasal bones (violet) of the dorsum identified, for effecting a nose-narrowing rhinoplasty.


Rhinoplasty: At 3-days post-operative, the patient wearing their nasal  splint  after a dorsal bone reduction, re-setting, and nasal-tip refinement. The  panda eyes  (orbital discoloration) is consequent to trauma and ocular blood vessel disruption.


Split-thickness skin graft donor site eight days after removal of the skin


A device called a DermaClose is used to help large wounds to heal, either in conjunction with a skin graft (as in this example) or as an alternative healing aid.


Illustration of body dysmorphic disorder (BDD)


Preparation of spray-on skin using a  ReCell  device


In combination with polydactyly


Delta shaped extra phalanx


Palmar grip


Deltoid-to-triceps transfer


Vaginal expander ZSI 200 NS


ZSI 200 NS vaginal expander stretching the female vagina


Labiaplasty , pre- and post-op. The labia minora has been reduced in size.


Vulva after  clitoral hood reduction  and labiaplasty


Four drawings illustrating the first tubed pedicle flap of  Vladimir Filatov , 1916


A photograph of Walter Yeo in 1917, showing his face before (left) and after the tube pedicle  flap  reconstruction of his face (right).


Diagram of a Z-plasty procedure.


A seven-week-old caesarean section  scar  and  linea nigra  visible on a 31-year-old mother: Longitudinal incisions are still sometimes used.


Transvaginal ultrasonography  of a uterus years after a caesarean section, showing the characteristic scar formation in its anterior part


Suturing of the uterus after extraction


Closed incision for  low transverse abdominal incision  after stapling has been completed


Several caesarean sections  Is: supra-umbilical incision  Im: median incision  IM: Maylard incision  IP: Pfannenstiel incision


Removal of the baby


Illustration depicting caesarean section


A baby being removed from its dying mother's womb


A caesarean section performed by indigenous healers in Kahura, Uganda. As observed by medical missionary  Robert William Felkin  in 1879.


Saint Caesarius of Terracina , invoked for the success of caesarean delivery


Fictional 15th-century depiction of the birth of Julius Caesar


Comparison of incisions used for  caesarean section  Is:  Supra-umbilical incision  Im:  Median incision  IM:  Maylard incision  IP:  Pfannenstiel incision


Patient in a symphysiotomy hammock after surgery, 1907


Queensland Ambulance Service  bariatric ambulance


Dr. Stanley Bernstein arrested for conspiracy to commit murder and possession of stolen property over


A "class III male living with obesity" with a BMI of 53 kg/m 2 : weight 182 kg (401 lb), height 185 cm (6 ft 1 in). He presents with  stretch marks  and  enlarged breasts .


Average per capita energy consumption of the world from 1961 to 2002 [ 107 ]


Prevalence of obesity in the adult population by region (2000–2016)


"La Monstrua Desnuda" (The Nude Monster), a 1680 painting by  Juan Carreno de Miranda  of a girl presumed to have  Prader–Willi syndrome [ 137 ]


The disease scroll ( Yamai no soshi , late 12th century) depicts a woman moneylender with obesity, considered a disease of the rich.


Obesity in developed countries is correlated with  economic inequality .


A comparison of a mouse unable to produce  leptin  thus resulting in obesity (left) and a normal mouse (right)


Prevalence of obesity in the adult population, top countries (2016)


Prevalence of obesity in the adult population in 2016


Share of adults with BMIs > 30 (2022)


During the  Middle Ages  and the  Renaissance   The Tuscan General  Alessandro del Borro , attributed to Charles Mellin, 1645 [ 230 ]


Venus of Willendorf  created 24,000–22,000 BC


Services accommodate obese people with specialized equipment such as much wider chairs. [ 250 ]


United States President   William Howard Taft  was often ridiculed for being overweight.


German politician  Ricarda Lang  is a victim of fat shaming on the internet. [ 261 ]


Rush hour in Copenhagen, where 62% of the population commute by bicycle to their work or study places each day


A trauma bay at  Kings County Hospital Center  in  Brooklyn , New York


Ferrada in 2021


Members of the 541st Forward Surgical Team (FST) (Airborne) perform an assessment of an Afghan man on Forward Operating Base (FOB) Farah, Afghanistan in support of Operation Enduring Freedom (OEF) on December 26, 2012.


Founded in 1940,  Birmingham Accident Hospital  in  Birmingham , United Kingdom, was the world's first trauma center.


Ohio State University Wexner Medical Center , a Level 1 trauma center in  Columbus, Ohio


Memorial Hermann–Texas Medical Center , a Level 1 trauma center in  Houston


Jackson Memorial Hospital , a Level 1 trauma center in  Miami


The trauma team works together to diagnose and treat the severely injured


Anesthesiologists play a role in the airway team


Trauma Nurses support the trauma team by use of an ECG


Deep wound on shin with stitches healing over five weeks


Approximate times of the different phases of wound healing on a logarithmic scale, [ 10 ]  with faded intervals marking substantial variation, depending mainly on wound size and healing conditions, but image does not include major impairments that cause  chronic wounds .


A  fluorescence micrograph  of cells in  Drosophila  larvae healing after a puncture wound. The arrow points to cells that have fused to form  syncytia , and the arrowheads point to cells that are oriented to face the wound. [ 14 ]


A scab covering a healing wound


Amputation of the thigh by a railway surgery team c. 1898


Head on collision on the  Bay of Quinte Railway , 1892


Amputation at the shoulder from the textbook  Railway Surgery [ 4 ]


John Eric Erichson


Sofie Herzog , the only female railway surgeon ever appointed in the US


Thomas Bond , railway surgeon to the  Great Western Railway


Divisional railway hospital,  Golden Rock, Tiruchirappalli ,  Tamil Nadu


A hospital car belonging to  Plant System  in Florida, view looking into the operating theatre


Diagram showing the position of the adrenal glands


Incidences and prognoses of  adrenal tumors ; [ 6 ]  over half of which are  benign (noncancerous).


Abdominal Anatomy


Small bowel resection


Colon Cancer


Bowel stricture


Abdominal free air


Ischemic small bowel


Surgeons performing laparoscopic surgery


Laparoscopic stapler resection of sigmoid colon


Suture anastomosis of sigmoid colon


Stapler anastomosis of sigmoid colon


Ileostomy patient with ostomy wafer


Transverse colectomy


Chest radiograph showing a stent in the distal esophagus


Diagram showing before and after an oesophago-gastrectomy


Tissue embedded within  optimal cutting temperature compound  (OCT), mounted on a chuck in a  cryostat , and ready for section production


Minimal time in solutions for frozen sections.


The spectrum of target antigens associated with tumor immunity and alloimmunity after allogeneic HSCT: Host-derived T and B cells can be induced to recognize tumor-associated antigens, whereas donor-derived B and T cells can recognize both tumor-associated antigens and alloantigens.


Bone marrow harvest


Peripheral blood stem cells


Hysterectomy


Myomectomy


Sutured uterus wound after myomectomy


Schematic drawing of types of hysterectomy


Anatomy of the larynx


Voice prosthesis


Transgender man with a  masculinized chest  via double lateral incision mastectomy


Laparoscopic nephrectomy


Diagram showing how the bowel is joined back together after a total pancreatectomy


The tissue removed during a pancreaticoduodenectomy


Whipple surgery


X-ray of a person who has had their right lung removed. Note how fluid has replaced the lung


Diagram showing the parts removed in a pneumonectomy


Portrait of William Halsted


Pectoralis Major


CT scan showing radiofrequency ablation of a liver lesion


Schematic view of a pulmonary vein ablation. The catheter reaches (from below) through the inferior vena cava, the right atrium and the left atrium, to the orifice of the left upper pulmonary vein.


Schematic representation showing  margin negative  (A) and  margin positive  (B) excisions of a lesion.  In a margin negative resection the lesion is completely removed; no lesional tissue is left behind the in the patient. In a margin positive resection some lesional tissue is left behind in the patient.


Micrograph  of a stained slide of a resected  myopericytoma , the resection margin stained brown


Micrograph  showing a positive cauterized surgical margin in an adenocarcinoma (center-top of image).  H&E stain .


Edges and margins for an intestinal tumor.


A partial vulvectomy of the top area of the vulva


A partial vulvectomy of one side of the vulva


A partial vulvectomy of the bottom area of the vulva


Upper lip deformity repaired using a skin flap from the forehead.


Aesthetic medicine advertisement targeting  teenagers , in Japan


Before tibial lengthening


Period of tibial lengthening


Tibia before correction and tibia after correction, immediately after Ilizarov apparatus removal


Correction of X-shaped curvature


Breast augmentation: cross-section scheme of the  mammary gland .  Chest wall Pectoralis muscles Lobules Nipple Areola Milk duct Fatty tissue Skin envelope


A functional breast: a mammary gland feeding an infant child.


Breast augmentation is an occasional recourse for women bodybuilders to retain the female figure lost when achieving a lean and muscular physique. (professional bodybuilder  Nikki Fuller )


Breast augmentation: The post-operative aspect of a right-breast cancer  mastectomy ; the woman is a candidate for a primary breast reconstruction with a breast implant.


Breast-implant failure: The parts of a surgically explanted breast-implant are the red, fibrous capsule (left), the ruptured silicone implant (center), and the transparent filler-gel that leaked to the woman's pectoral tissues (right).


Breast-implant failure: Capsular contracture is a medical complication, in this case, a Baker scale Grade IV contraction, of a subglandular silicone implant in the right breast.


Breast Implant: the chest X-ray of a woman with bilaterally emplaced breast implants shows that the prostheses are radiographically opaque, and are foreign objects in her body, but not of her body.


Breast-implant: The metallic element  platinum  (Pt, 78) a  catalyst  in the manufacture of  silicone  breast implants, was a suspected cause of toxic contamination (tissue ionization) in the bodies of women with such implants.


Non-implant breast augmentation: the pre-procedural aspects (left) and the post-procedural aspects (right) of breasts enlarged and contoured with autologous fat grafts


Fat-graft breast augmentation: the pre-operative aspects (left) and the post-operative aspects (right) of a large-volume non-surgical augmentation


Fat-graft breast augmentation: the pre-operative aspects (left) and the post-operative aspects (right) of a medium-volume non-surgical augmentation


Surgical anatomy of the  mammary gland  for reduction mammoplasty correction:  Chest wall Pectoralis muscles Lobules Nipple Areola Milk duct Fatty tissue Skin envelope


Breast reduction: the pre-operative (l.) and post-operative (r.) aspects of the correction of macromastia and breast ptosis in a young woman.


Reduction mammoplasty: The keyhole incision plan for correcting  macromastia ; the sagging, hypertrophied breast (l.), the surgical reduction procedure (c.), the reduced, elevated breast (r.).


Breast reduction: foremost is the tissue viability of the NAC; it also hides a periareolar scar in the skin-color transition at the areolar periphery.


Reduction mammoplasty: The vertical scar technique (lollipop incision) and the inferior pedicle flap technique (anchor incision) also are applicable to  breast lift  surgery.


Gluteoplasty:  The surgical anatomy of the gluteus maximus muscle, as considered for a buttock-lift surgery.


Actor  Melusi Yeni  became the 1 millionth  VMMC against HIV/AIDS transmission  in the  province  of  KwaZulu-Natal , South Africa. [ 29 ]


Before (left) and after (right) an adult circumcision that was undertaken to treat  phimosis . After the operation, the  glans  is exposed even when the penis is  flaccid .


Circumcision knife from the Congo; wood, iron; late 19th/early 20th century


Detail of the  Artemision Bronze ; the Greeks abhorred circumcision, making life difficult for circumcised Jews living among the Greeks.


The Circumcision of Jesus Christ, by  Ludovico Mazzolino


The first medical professional to recommend circumcision as a  prophylaxis  against disease was the  British  physician  Jonathan Hutchinson  in 1855. By the late 19th century, the belief that circumcision acted as an effective prophylactic against disease was held by a majority of the  core Anglosphere 's medical communities and doctors, such as the prominent  Lewis Sayre , president of the  American Medical Association , subsequently leading to its widespread adoption. [ 21 ]


Pediatrician and political activist  Benjamin Spock  recommended circumcision in his influential work  The Common Sense Book of Baby and Child Care , one of the best-selling books of the twentieth century. [ 109 ]


A circumcision being performed in Central Asia,  c.  1865–1872


Preparing for a Jewish ritual circumcision


Children in Turkey wearing traditional circumcision costumes


Boys in white clothing with bonnets at  Tireli  market, just after circumcision, Mali, 1990


Coptic  Children wearing traditional circumcision costumes


Preparing for a ritual circumcision to a  Druze  child


A drawing of a luxury  hourglass corset  from 1878, featuring a  busk  fastening at the front and lacing at the back


Pair of stays, c.1780s.  Fashion Museum, Bath , England.


Advertisement of corsets for men, 1893


Advertisement of corsets for children, 1886


X-ray of a woman in a corset


Woman's corset (stays)  c.  1730 –1740.  Silk   plain weave  with supplementary  weft -float patterning, stiffened with  baleen ;  Los Angeles County Museum of Art , M.63.24.5. [ 24 ]


A pair of quilted linen jumps, late 17th-early 18th century


"Lacing a Dandy," a satirical cartoon of a man being laced into a corset, 1819


A maternity corset, 1908


Eugène Atget, Boulevard de Strasbourg, Corsets, Paris, 1912


Diagram of a straight-front corset, 1902


A longline hip-slimming corset, 1917


Singer  Rihanna  wearing a modified corset along with  underwear as outerwear .


BDSM neck collar and corset


Ill shaped nose of a young girl suffering from syphilis.


Walter Yoe, a patient of  Harold Gillies  who received  flap surgery .


Silicone breast implant.


Laser being used within the field of tattoo removal.


A building in Busan, housing several cosmetic surgery clinics.


A before and after comparison of a double eyelid surgery.


Jessi is a Korean artist that has been very open about the cosmetic surgery she has received.


Contemporary Mursi woman showing pierced lower lip without a lip plate


Mursi woman wearing a lip plate in Ethiopia


Raoni Metuktire , a  Kayapo  man, speaking at the Brazilian Commission on Human Rights and Participatory Legislation


Young  Haida  woman with lip plate, portrayed in  Dixon, George  (1789):  Voyage autour du monde


A  Kayan  woman wearing neck rings


The Celtic gold  Snettishham Torc , England, 1st century BC.


A Kayan Lahwi girl in 2004


Traditional Ndebele dress


Perineoplasty: The internal, muscular anatomy of the female perineum.


Maxi Mounds , an adult entertainer with polypropylene breast implants


Chelsea Charms (middle), who has polypropylene breast implants, standing alongside Echo Valley (left) & Colt 45 (right).


Gross pathology of a  tubulovillous adenoma  resected by  minimally invasive colorectal surgery .


Intersphincteric fistula in the lower anal canal. Ultrasound image where the fistula is labeled with a letter F.


Japan: A man with an anal fistula. From the Yamai no Soshi, late 12th century.


Stylized diagram showing action of the puborectalis sling, and the formation of the anorectal angle. A-puborectalis, B-rectum, C-level of anorectal ring and anorectal angle, D-anal canal, E- anal verge , F-representation of internal and external anal sphincters, G-coccyx & sacrum, H-pubic symphysis, I-Ischium, J-pubic bone.


Germ cells tumors constitute a vast majority of the incidences of  testicular tumors . [ 3 ]


An  external hemorrhoid


Gross pathology  of hemorrhoids, showing engorged blood vessels


A  thrombosed  external hemorrhoid


An 11th-century English miniature. On the right is an operation to remove hemorrhoids.


Two female pinworms next to a ruler: The markings are 1 mm apart.


Life cycle of  E. vermicularis  showing the stages inside and outside of the human body


Two female pinworms next to a ruler. The markings are one millimetre apart.


Pinworm life cycle.


High magnification  micrograph  of a pinworm in  cross section  in the  appendix .  H&E stain .


A proctoscope (middle) with an  anoscope  and a rectoscope


Two proctoscopes


Two (2)  pilonidal cysts  in the  intergluteal cleft  showing mucopurulent discharge.


A . Internal rectal intussusception.  B . External (complete) rectal prolapse


A. Normal anatomy: (r) rectum, (a) anal canal   B. Recto-rectal intussusception   C. Recto-anal intussusception


A severe example of complete (external) rectal prolapse. Note circumferential arrangement of mucosal folds.


Micrograph  showing a rectal wall with changes seen in rectal prolapse. There is a marked increase of fibrous tissue in the submucosa and fibrous tissue +/- smooth muscle  hyperplasia  in the  lamina propria .  H&E stain


Surgeon operating


Visual scale for the quantification of hyperhidrosis


Gross anatomy of the lungs. Note the five lung lobes divided by the three lung fissures and the main, lobar and segmental bronchi.


The mechanical arm module of a surgical robot.


STS Logo


The incisors and first molars start to erupt between the ages of 6 and 8 years.


Panorex xray showing defect (red arrow) in the alveolus with maxillary canine tooth erupting into the cleft about age 13


Fan rapid palatal expander in cleft palate prior to alveolar cleft grafting


Incisions used in alveolar cleft grafting.  Red arrow marks oro-nasal fistula, blue lines mark incisions


Location of the incision to harvest bone from the anterior iliac crest


Orthodontics start 3 months after surgery.


A porous bioceramic granule of an orthobiologic calcium composition manufactured by Cam Bioceramics


A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup


Illustration of an autograft harvested from iliac crest


A bone allograft


Flexible hydrogel-HA composite, which has a mineral-to-organic matrix ratio approximating that of human bone


Schematic representation of the principle of bone segment navigation; DRF1 and DRF2 = IR


Using the  SSN  in the operating theatre; 1=IR receiver, 2 and 4=IR Reference devices, 3=SSN-Workstation


Bonwill Triangle


Scar remained from a cranioplasty


A trepanned skull


Portrait of Gabriele Fallopius


Sir William Macewen, who reported a case of successful autograft cranioplasty in 1885


Tessier classification. Left: boney clefts, Right: Soft tissue clefts.


Bilateral number 4 orbital clefts


Partial 3-11 orbital cleft


Hyo-mandibular suspension: Base hyoid position before advancement.


Hyo-mandibular suspension: Hyoid advanced with ghost image of original hyoid position. Shown using Encore hyoid system by Siesta Medical.


Hyo-mandibular suspension: Completed suspension.


obtained from the  CT  "slices"


A 3D CT reconstruction showing a Le Fort I fracture (arrow indicates fracture line)


The facial skeleton


The orofacial pain region: "pain localized to the region above the neck, in front of the ears and below the  orbitomeatal line , as well as pain within the oral cavity; [including] pain of dental origin and temporomandibular disorders". [ 5 ]


Titanium implant (black) integrated into bone (red): Histologic section


X-ray  of Femoral Osteotomy hardware to correct femoral rotation caused by hip dysplasia. X-ray of the right hip in female patient in early thirties.


a. X-ray of a hip after capsulorrhaphy and Dega surgery. b. Same hip after addition of Chiari medial displacementosteotomy. [ 4 ]


Valgus osteotomy. The black line is the mechanical axis.


Visual image of the face of the person shown on the CT scan above. Swelling can be observed in the right cheek.


Histopathology of a periapical cyst, with metaplastic changes of mucus-secreting cells (B), and ciliated cells (C).


Cholesterol clefts of a periapical cyst of the jaw.


Relative incidence of odontogenic cysts. [ 14 ]  Periapical cysts are labeled at left.


Splint activator type "K3F", frontal view...


...and back view


Surgical planning using  bone segment navigation  for the osteotomy of the jaw bones, based on models fixed into an  articulator  (registration based on infrared devices)


Surgical planning using  bone segment navigation  for the osteotomy of the left  orbit , based on  stereolithographic models  (registration based on infrared devices)


Surgical navigation  for the orbit and  zygoma  on the SSN system (Color coding for the preoperative, predicted and goal position of the fragments, respectively)


Peptic ulcer disease, an ailment commonly corrected by antrectomy.


Billroth II (BII) reconstruction method


Theodor Billroth, the first physician to execute a successful gastrectomy


Visual representation of stomach cancer, a condition that could be directly resolved by antrectomy


Gastric endoscopy, a procedure gradually replacing the need for antrectomy.


Four incisions for an appendectomy, corresponding to the order listed.


Hasson Entry: The two red lines mark the sites of the 5mm laparoscopic ports. The blue line above the umbilicus marks the site of the camera port


Surgeons perform a laparoscopic appendectomy.


Wound healing - ten days after a laparoscopic appendectomy


Inflamed appendix removal


Laparoscopic-assisted transumbilical appendectomy scar on a pediatric patient. Anesthetic result one month after surgery.


Scar and bruise 2 days after operation


Scar 10 days after operation


An appendectomy at the French Hospital in  Tbilisi, Georgia , 1919


Method of removing a polyp with a snare


Illustration depicting various types of colostomy


Patient with a colostomy complicated by a large parastomal hernia, which is when tissue protrudes adjacent to the stoma tract.


CT scan  of same patient, showing intestines within the hernia.


Scar from midline incision for exploratory laparotomy


Gastroenterostomy, anastomosis of gastric cardia to jejunum


Hemorrhoids before and after hemorrhoidal artery embolization


Ileostomy with bag (pouch).


Polypropylene mesh used for inguinal hernia surgery


Inguinal Hernia Patch. Animation in the reference. [ 28 ]


Bassini technique, first suture. 1. Aponeurosis musculi obliq. ext.; 2. Musculus obliquus internus; 3. Musculus transversalis; 4. Fascia transversalis; 5. Peritoneum; 6. Ligamentum inguinale.


Port sites for inguinal hernia repair


Intraoperative view by TEP Operation. 1. Genital ramus of genitofemoral nerve. 2. Preperitoneal lipom and spermatic cord.


The potential benefits and risks of different approaches to inguinal hernia. [ 72 ] [ 73 ] [ 74 ] [ 75 ] [ 76 ] [ 77 ] [ 78 ] [ 79 ]  Graphic from NHS England decision aid. [ 80 ]


Most hernia repairs are done under general anaesthetic, which carries some risks. [ 85 ]


Prescription parenteral nutrition formulation.


Isolated intestine transplant diagram.


Cholecystectomy  as seen through a laparoscope. Clockwise from the top left, the text reads: ' Gallbladder ', ' Cystic artery ', 'In bag coming out,' and  Cystic duct .


Surgeons perform laparoscopic stomach surgery.


Laparoscopic instruments


A laparoscopic robotic surgery machine


Hans Christian Jacobaeus


A completed Nissen fundoplication


PEG tube, cannula and guidewire (Pull Technique)


Endoscopic removal of PEG tube


Drawing showing pyloric stenosis before and after surgery


Horizontal surgical wound 10 days after pyloromyotomy in a four-week-old baby


Necrotizing enterocolitis , a potential cause of SBS


Diagram showing before and after stomach bypass surgery.


Image of sleeve gastrectomy showing the reduced, new stomach (the gastric sleeve) and the removed stomach tissue (resected stomach).


Realización de gastrectomía.


Image of Roux-en-Y gastric bypass showing the new connection, formed by staples, of the smaller portion of the stomach connected to a further part of the small intestine.


Roux-en-Y gastric bypass.


Biliopancreatic diversion


Image of a  Vertical banded gastroplasty  showing staples and a gastric band creating the reduced, new stomach (labeled stomach pouch in the image). [ 67 ]


Image of an adjustable gastric band in place over the upper portion of the stomach


Cataract surgery, using a temporal approach  phacoemulsification  probe (in right hand) and "chopper" (in left hand) being done under operating microscope at a Navy medical center


Vitrectomy


Isolating the inferior rectus muscle


Disinserting the medial rectus muscle, after placing vicryl suture


A  surgeon  operating.


Indirect  ophthalmoscopy


Fluorescein angiography


An ophthalmologist performing surgery


Anatomy of the Eye, 1200 A.D.


Early Ophthalmology instruments


New York Ophthalmic Hospital, 1893


Albrecht von Graefe


Allvar Gullstrand


Oral palate unit


Anatomy of oral cavity and adjacent structures


Infixing a distal femoral traction pin, preopt for a fractured femur.


Preparing a cow for udder surgery in field conditions: the physical restraint with a set of ropes is necessary next to xylazine tranquilisation


A cat spay


Pyometra  surgery


Anesthetised dog with an  epulis


X-ray of a dog with an artificial hip to repair hip dysplasia


A healthy tortoise-mix cat healed and adapted quickly to her new mobility after a hind leg was amputated.


Cystotomy to remove bladder stones


Sutured wound on the teats of a cow


Bottle top swallowed by a dog that had to be removed surgically


James Styner with three of his children who all received severe head trauma in the crash


Styner's  Beechcraft Baron  after the crash


Signs of break in the base of the skull may include  bruising behind the ears  or around the eyes, or blood behind the ear drum. Blood or cerebrospinal fluid can leak from the nose or ear


FAST Algorithm


Deaths from injuries per million persons in 2012     203-358    359-428    429-483    484-559    560-637    638-716    717-817    818-939    940-1,140    1,141-2,961


Deaths from intentional injuries per million persons in 2012     14-65    66-89    90-114    115-137    138-171    172-193    194-226    227-291    292-379    380-2,730


Burns by severity


A  black eye , a common facial injury.


Types of bone fracture


CT scan  of a brain hemorrhage (bottom arrow) and the surrounding  edema  (top arrow)


Trauma surgeons operating on a United States Marine


Radiograph of a close-range  shotgun   blast injury  to the  knee .  Birdshot pellets  are visible within and around the shattered  patella , distal  femur , and proximal  tibia


Whole body radiograph of traumatic injuries notable for fractures of both femurs (thigh bones), indicating major trauma


A  Navy corpsman  listens for the correct tube placement on an  intubated  trauma victim during a  search and rescue  exercise


Typical trauma room


Deaths from injuries per 100,000 inhabitants in 2004 [ 79 ]              no data      < 25      25–50      50–75      75–100      100–125      125–150          150–175      175–200      200–225      225–250      250–275      > 275


Incidence of accidents by activity in Denmark


National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR)


National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR)


A superficial gunshot wound to the  armpit


X-ray showing a bullet (white spot) in the heart


Ambroise Paré


One of the U.S. clinics specialising in polytrauma, this one in  Palo Alto


Most common causes of pediatric trauma


An example EKG for pulseless electrical activity. In this rhythm, cardiac activity will be seen on electrocardiogram, but a pulse will not be felt on provider's exam.


An EKG showing asystole, or "flat-lining."


Echocardiogram is a study in which an ultrasound is used to exam the function of the heart. In Traumatic cardiac arrest, an echocardiogram may show ineffective motion of the heart and may provide clues that point to a specific cause of the arrest.


Wound contracture following deep burn injury


The ancient Greek method for treating cystocele


Synthesis of dapoxetine


A 1932 drawing by Didusch


During the emission phase of ejaculation, sperm travels from the  epididymis  through the  vas deferens  mixing with fluids from the  male accessory glands  as it enters the urethra. During the expulsion phase, rhythmic contractions of the  pelvic floor  and  bulbospongiosus muscles  expel the semen from the penis through the  urinary meatus  in several spurts.


Diagram of the male pelvic and reproductive organs


Corpus spongiosum of a human penis


Veins and arteries of a human penis in cross section


Gleason pattern 3.  H&E stain .


Gleason pattern 4.  H&E stain .


Gleason pattern 4 (left of image) and Gleason pattern 5 (right of image).  H&E stain .


EAU Munchen  Award


Intravesical drug delivery through a urinary catheter


The layers of the urothelium.


A mucoadhesive formulation adhered to bladder wall through interactions with urothelium's mucin layer.


Placement of electrodes for EMDA on the urinary bladder.


Diagram of an open vasectomy


A rolled-up condom


A diagram of the mechanism of action of vas-occlusive contraceptive methods.


Plastic pants suitable for nocturnal enuresis in larger child or small adult


Properties of common prostate cancer cell lines


Actin (Phalloidin) and Nuclei (DAPI) staining


PC3 cell cultured in plastic plate


A penis clamp.


Risk of prostate cancer in two age groups based on  Free PSA  as % of Total PSA [ 65 ]


San Francisco City Clinic , an STI testing center in  San Francisco


St. Peter's Hospital, Covent Garden, London.


Muscles of the pelvic floor in males and females and location of urethra.


Pelvic organs including bladder and urethra in both males and females.


Scanned electron photograph of E.Coli


Chemical structure of nitrofurantoin


Chemical structure of fosfomycin


Chemical structure of beta-lactam


Chemical structure of one of the most used fluoroquinolone - ciprofloxacin


Painting showing the physician  Constantine the African  accepting urine samples for diagnosis


A sign in  Fortaleza ,  Brazil , warning that public urination is illegal


A man uses a  urinal , voiding urine in a standing position.


Male mammals detect  estrus  from chemical signals in the female's urine [ 64 ]


An abscess


A naturally drained abscess


Ultrasound image showing an  abscess, appearing as a mushroom-shaped dark (hypoechoic) area within the fibroglandular tissue of the breast


Abscess five days after incision and drainage


Abscess following  curettage


Location of  McBurney's point  (1), located two thirds the distance from the umbilicus (2) to the right anterior superior iliac spine (3)


Location of the appendix in the  digestive system


3D model of appendicitis.


CT scan showing acute appendicitis


An  ultrasound  image of acute appendicitis in December 2008


A CT scan demonstrating acute appendicitis (note the appendix has a diameter of 17.1 mm and there is surrounding fat stranding)


A  fecalith  marked by the arrow that has resulted in acute appendicitis.


Appendicolith as seen on plain X-ray


Coronal   CT scan  of a person initially suspected of having appendicitis because of right-sided pain. The CT shows in fact an enlarged  inflamed gallbladder  that reaches the right lower part of the abdomen.


Inflamed appendix removal by open surgery


Laparoscopic appendectomy.


Laparoscopic view of a phlegmonous cecal appendix with fibrinous plaques, located in the right iliac fossa.


Laparoscopic-assisted transumbilical appendectomy scar on a pediatric patient. Anesthetic result one month after surgery.


The  stitches  the day after having the appendix removed by laparoscopic surgery


Appendicitis deaths per million persons in 2012       0      1      2      3      4      5–7      8–11      12–33      34–77


Disability-adjusted life year  for appendicitis per 100,000 inhabitants in 2004. [ 105 ]        no data      less than 2.5      2.5–5      5–7.5      7.5–10      10–12.5      12.5–15      15–17.5      17.5–20      20–22.5      22.5–25      25–27.5      more than 27.5


A small bowel obstruction as seen on CT


Average inner diameters and ranges of different sections of the large intestine. [ 15 ]


Upright abdominal X-ray demonstrating a small bowel obstruction. Note multiple air fluid levels.


Upright abdominal X-ray of a person with a large bowel obstruction showing multiple air fluid levels and dilated loops of bowel


Meckel's diverticulum surgical specimen


Technetium-99m Pertechnetate Scan with a Meckel's Diverticulum.


Angiography of a Meckel's diverticulum that presented with bleeding.


Site of tubo ovarian abscess, a type of pelvic abscess in females


Speculum


Colposcope


Hysteroscopic image of an endometrial ablation procedure


Caesarean section operation


Location of a low transverse incision and midline vertical incision


Legal prohibition of non-consensual medical interventions    Regulatory suspension of non-consensual medical interventions    Physical integrity and bodily autonomy on intersex not legislated


Licence to Lie and to Mutilate: "even the most enthusiastic proponents of prophylactic castration" [ 30 ]  - treatment of  androgen insensitivity syndrome  in 1963


ILGA conference 2018, group photo to mark  Intersex Awareness Day


Intersex banner reading "End Intersex Surgery,"  Berlin Pride  27 June 2020


Uterine Prolapse, an example of pelvic organ prolapse (POP)


Lateral cross section of female reproductive system, illustrating the vesicovaginal and rectovaginal areas


Tissue Fixation System (TFS) invented in Australia, an example of mesh implant to repair pelvic organ prolapse and stress urinary incontinence.


The uterus being removed in a laparoscopic vaginal hysterectomy


Diagram of female genitalia


Cryogun used to spray liquid nitrogen


Divided Mohs Section


Pacman 1 Piece


Double Pacman


Pictogram of  CCPDMA  or margin controlled histology


Pictogram of standard  bread loafing  histology


False negative in standard bread loafing histology


Comparing Mohs Method to Smashing an Aluminum Piepan


How a Mohs section is flattened with relaxing incisions


A physician performing laser resurfacing using an erbium laser


Punch biopsy


WOFAPS Executive Board in 2019–2022 at WOFAPS 7th Congress in Prague, Czech Republic


Cardiac surgery at  Gemelli Hospital  in Rome


Bicuspid aortic valve which had to be operated on for severe regurgitation. Two of the cusps (upper side right and left) are grown together (fused) since birth. The lack of closure is seen in the central part of the valve, it is caused by stretching of the fused cusp.


Repaired bicuspid aortic valve. The stretching of the fused cusp has been corrected by sutures, the correct coaptation of the cusps is easily visible.


Cross-section of the heart, viewed from the front. The aortic valve separates the  left ventricle  from the  aorta .


Heart viewed from above, with atria removed to expose the valves. The aortic valve has three sections called leaflets that open to let blood flow.


Components of an AVB implant: the Hancock connector and Medtronic Freestyle  porcine valve. The surgeon sutures these together on the back table within the operating room.


A variety of coring tools have been created by surgeons performing AAC or AVB.


Complete AVB Kit: Left Ventricle Connector, Valved Conduit, and Installation Tool shown with connector installed


Patient positioning for a left anterior thoracotomy


Illustration of arterial switch operation


3D Medical Animation still shot of Artificial Heart Valve


Caged ball valve


tilting-disc valve


Bileaflet valve


Blalock–Thomas–Taussig shunt – A) original procedure – B) modified procedure


CVT anesthesologist at work in University of Miami