Dr. Mark Arthur Dettelbach, MD

Normally, the tears that constantly bathe the eyes are drained through two tiny holes in the eyelid, where they run through a duct into the nose. This tear duct can become clogged or blocked, causing tears to back up and leading to watery eyes. Common causes of tear duct blockages include trauma, a facial tumor, and inflammation due to certain medical conditions, but usually the cause is not known. Clogged tear ducts are especially common in young children. If the blockage is permanent and located lower in the duct, near the nose, DCR may be performed to create a bypass and allow tears to drain freely again.

During DCR surgery, a small hole is made in the bone and tissue between the upper part of the tear duct and the nasal passage. Usually, a tiny plastic tube called a stent is placed into the opening to protect it and keep it open during healing. DCR may be performed through an open incision on the upper cheek near the nose, or it may be performed endoscopically using tiny instruments that are passed through the nostril. Open surgery is more common, and has a slightly higher success rate, although endoscopic surgery causes less pain and bleeding during recovery. DCR is able to correct the blockage and watering eyes in nearly 95% of cases.

The surgery itself takes only about half an hour. It is usually done under general anesthesia, which may require a short hospital stay while patients recover. Small amounts of bleeding from the nose are not uncommon for the first 24 hours, and bruising and swelling are expected for the first two weeks. Don't be alarmed if the eye continues to water at first. Swelling in the area due to surgery can cause the eye to water, but this should go away as patients heal.

TMJ can cause a wide variety of symptoms related to the movement of the jaw. They can include earaches, headaches, an inability to open the mouth very far, painful clicking or popping noises when chewing or talking, and stiffness or pain in the jaw, face, or neck. Sometimes TMJ symptoms seem to go in cycles, getting better or going away for a while only to come back again. Symptoms can be mild and not very bothersome, or so persistent and painful as to be almost debilitating.

There can be many potential causes of TMJ. An injury or trauma to the jaw, arthritis, or grinding the teeth can all contribute to TMJ. The temporomandibular joint contains a small disc of cartilage that allows it to move smoothly, and this disc can become dislocated or torn. Sometimes the cause is unknown. There are no standard tests for TMJ, and it can be difficult to diagnose and treat.

Mild cases of TMJ may benefit from self-care such as eating soft foods, practicing stress management techniques, and applying ice packs to the jaw. NSAIDS, such as ibuprofen, can be purchased without a prescription and work to reduce pain and inflammation. Some dentists and occupational therapists can suggest stretching techniques for the jaw which may help relieve stiffness. More serious cases may require a form of splinting called a stabilization splint or bite plate, which helps reduce pressure on the joint. Extreme cases may benefit from arthroscopic surgery on the joint.

Tonsillectomies are usually performed on children; however, many adults also undergo the procedure. A tonsillectomy generally only lasts for about half an hour following the administration of anesthesia. The otolaryngologist (ENT) or surgeon performing a tonsillectomy may employ a variety of medical techniques, such as:

• Cold Knife Dissection: A cold knife dissection is the most popular tonsil removal method. A surgeon removes the tonsils using a steel scalpel and repairs the region with sutures (stitches) or electrocautery (high heat) to stop bleeding. This technique is favored for those with obstructed breathing.
• Electrocautery: Other tonsillectomy methods include a full tonsil removal by electrocautery, where the surgeon uses a high heat device to burn off the tonsils and cauterize the bleeding tissue. Electrocautery is more painful than cold knife dissection.
• Harmonic Scalpel: A third technique is where the surgeon uses a harmonic scalpel (vibrating bladed device) to first cut off the tonsils, and then coagulate bleeding using the harmonic scalpel's heat and vibration. Harmonic scalpel is the most precise form of tonsillectomy.
• Radiofrequency Ablation: To perform the radiofrequency ablation technique, the surgeon places small probes into the tonsil that transmit radiofrequency energy to the tonsil tissue. The delivered energy damages and scars the tonsils, gradually minimizing the tonsils' size. Unlike the other three methods, radiofrequency ablation is performed in-office with or without general anesthesia and has minimal recovery time. Patients can expect to return to daily activities nearly immediately and may receive radiofrequency ablation every few months. While radiofrequency ablation does reduce tonsil inflammation, it is not often prescribed to those with severe tonsillitis or breathing disorders.

Patients are typically able to return home shortly after having their tonsils removed. Tonsillectomy recovery time may range from around ten days to two weeks. During this time, it is common for patients to have a sore throat, neck pain, and a hoarse voice. Patients are advised to consume soft foods such as ice cream and applesauce to avoid further throat irritation. After recovering from tonsillectomy, many patients experience improved breathing, reduced irritation, and an overall improved quality of life.