MASTICATION
M
TYPES OF MASTECTOMY
The type of operation depends on
many factors, including the size and
site of the tumour and the woman’s
wishes. A small tumour may be
treated by lumpectomy; other cases
may require more extensive surgery.
LUMPECTOMY
Site of incision for a lumpectomy
Only the cancerous tissue (shown here by a
dotted line) and some ofthe surrounding
normal tissue is removed. Lumpectomy
leaves the breast looking relatively normal.
TOTAL MASTECTOMY
1
A large, elliptical incision that
encompasses the nipple and
sometimes the entire breast, is made.
Part ofthe incision is extended into the
armpit. All ofthe breast tissue, including
the skin and some ofthe fat, is dissected
(separated by cutting) down to the chest
muscles. The dissection is continued under
the skin into the armpit, to free the upper
and outer “tail” of breast tissue with its
lymph nodes.
2
All ofthe bleeding vessels are tied off,
then a drainage tube is inserted and
the skin is closed with stitches or clips.
The scar runs diagonally across the chest.
The woman may wear a prosthesis or may
have an implant inserted later.
r e m o v a l o f a l l o f t h e b r e a s t t i s s u e a n d
u s u a l l y s o m e o r a l l o f t h e
l y m p h n o d e s
i n
t h e
a r m p i t .
C e l l s
f r o m
t h e
n o d e s
a r e
e x a m i n e d t o d e t e r m i n e w h e t h e r c a n c e r -
o u s c e l l s h a v e s p r e a d . T h e o p e r a t i o n i s
p e r f o r m e d u n d e r a g e n e r a l
a n a e s t h e s i a
a n d u s u a l l y r e q u i r e s a s t a y i n h o s p i t a l o f
a f e w d a y s .
P l a s t i c s u r g e r y
t o r e c o n s t r u c t
t h e
b r e a s t
m a y
b e
c a r r i e d
o u t
a t
t h e
s a m e
t i m e
a s t h e m a s t e c t o m y
o r a t a
l a t e r d a t e ( s e e
m a m m o p l a s t y
).
RISKS
A f t e r
t h e
o p e r a t i o n ,
t h e
s c a r
m a y
b e
t e n d e r .
I f t h e l y m p h n o d e s h a v e
b e e n
r e m o v e d , t h e r e i s a r i s k o f
l y m p h o e d e m a
d e v e l o p i n g i n t h e a r m .
m a s tic a tio n
T h e
p r o c e s s
o f
c h e w i n g
f o o d .
T h e
c a n i n e s a n d i n c i s o r s ( f r o n t t e e t h ) s h e a r
t h e
f o o d . T h e
t o n g u e
t h e n
p u s h e s
i t
b e t w e e n t h e u p p e r a n d l o w e r p r e m o l a r s
a n d m o l a r s
( b a c k t e e t h )
t o b e g r o u n d
b y m o v e m e n t s o f t h e l o w e r j a w .
S a l i v a
i s
m i x e d w i t h t h e f o o d t o h e l p
b r e a k i t
d o w n f o r s w a l l o w i n g .
m a s titis
I n f l a m m a t i o n o f
b r e a s t
t i s s u e . M a s t i t i s i s
u s u a l l y
c a u s e d
b y
b a c t e r i a l
i n f e c t i o n
a n d s o m e t i m e s b y h o r m o n a l c h a n g e s .
CAUSES
M a s t i t i s
u s u a l l y
o c c u r s
w h e n
b a c t e r i a
e n t e r t h e n i p p l e d u r i n g
b r e a s t - f e e d i n g
.
I t
c a n a l s o b e c a u s e d b y c h a n g e s i n l e v e l s
o f
s e x h o r m o n e s
i n t h e b o d y - f o r e x a m -
p l e , a t t h e o n s e t o f
p u b e r t y
.
SYMPTOMS
T h e c o n d i t i o n c a u s e s p a i n , t e n d e r n e s s ,
a n d
s w e l l i n g
i n
o n e
o r
b o t h
b r e a s t s .
B a c t e r i a l m a s t i t i s d u r i n g b r e a s t - f e e d i n g
a l s o c a u s e s r e d n e s s a n d
e n g o r g e m e n t
a n d
m a y r e s u l t i n a
b r e a s t a b s c e s s
.
TREATMENT
M a s t i t i s d u e t o i n f e c t i o n i s t r e a t e d w i t h
a n t i b i o t i c d r u g s
a n d
a n a l g e s i c d r u g s
,
a n d
b y
e x p r e s s i n g m i l k
t o
r e l i e v e
e n g o r g e -
m e n t .
M a s t i t i s
c a u s e d
b y
h o r m o n a l
c h a n g e s
u s u a l l y
c l e a r s
u p
i n
a
f e w
w e e k s w i t h o u t t r e a t m e n t .
m a s to c y to s is
A n
u n u s u a l
c o n d i t i o n i n w h i c h i t c h y ,
i r r e g u l a r , y e l l o w o r o r a n g e - b r o w n s w e l -
l i n g s o c c u r o n t h e s k i n , m o s t c o m m o n l y
o n
t h e
t r u n k .
M a s t o c y t o s i s
m a y
a l s o
a f f e c t b o d y o r g a n s , i n c l u d i n g t h e l i v e r ,
s p l e e n ,
a n d
i n t e s t i n e ,
a n d
m a y
c a u s e
s y m p t o m s s u c h a s d i a r r h o e a , v o m i t i n g ,
a n d
f a i n t i n g .
V e r y
r a r e l y ,
i t
l e a d s
t o
a n a p h y l a c t i c s h o c k
( a
s e v e r e
f o r m
o f
a l l e r g i c r e a c t i o n ) , w h i c h c a n b e f a t a l .
M a s t o c y t o s i s u s u a l l y b e g i n s i n t h e f i r s t
y e a r
o f l i f e
a n d c l e a r s u p
b y a d o l e s c -
e n c e .
A n t i h i s t a m i n e d r u g s
m a y b e h e l p f u l
i n r e l i e v i n g t h e s y m p t o m s .
m a sto id
T h e l o w e r p a r t o f t h e t e m p o r a l b o n e i n
t h e
s k u l l
.
T h e m a s t o i d h a s a p r o j e c t i o n ,
c a l l e d t h e m a s t o i d p r o c e s s , w h i c h c a n b e
f e l t b e h i n d t h e e a r . T h e b o n e i s h o n e y -
c o m
b e d w i t h
c a v i t i e s
c a l l e d
a i r
c e l l s ;
t h e s e s p a c e s a r e c o n n e c t e d t o a l a r g e r
c a v i t y c a l l e d t h e m a s t o i d a n t r u m , w h i c h
l e a d s i n t o t h e m i d d l e e a r .
I n
s o m e
c a s e s ,
i n f e c t i o n s
o f
t h e
m i d d l e
e a r
( s e e
o t i t i s m e d i a
)
s p r e a d
t h r o u g h
t h e
m a s t o i d
b o n e
t o
c a u s e
a c u t e
m a s t o i d i t i s
.
LOCATION OF MASTOID
The mastoid is the lower part of the
temporal bone. The mastoid process
can be felt as a hard prominence just
behind the ear.
M a s t o i d
T e m p o r a l
m a s to id itis
I n f l a m m a t i o n o f t h e
m a s t o i d
,
i n t h e s k u l l .
CAUSE
M a s t o i d i t i s i s d u e t o i n f e c t i o n s p r e a d i n g
f r o m t h e m i d d l e e a r ( s e e
o t i t i s m e d i a
)
t o
t h e a i r c e l l s i n t h e m a s t o i d t h r o u g h a
c a v i t y c a l l e d t h e m a s t o i d a n t r u m .
SYMPTOMS
T h e c o n d i t i o n c a u s e s e a r a c h e a n d s e v e r e
p a i n ,
s w e l l i n g ,
a n d t e n d e r n e s s b e h i n d
t h e
e a r . T h e r e
i s
u s u a l l y
a l s o
f e v e r ,
a
c r e a m y d i s c h a r g e f r o m t h e e a r , p r o g r e s -
s i v e h e a r i n g l o s s , a n d d i s p l a c e m e n t o f
t h e o u t e r e a r . I f t h e i n f e c t i o n s p r e a d s , i t
m a y l e a d t o
m e n i n g i t i s
,
a
b r a i n a b s c e s s
,
b l o o d c l o t t i n g i n v e i n s w i t h i n t h e b r a i n ,
o r
f a c i a l p a l s y
.
TREATMENT
T r e a t m e n t i s w i t h
a n t i b i o t i c d r u g s
.
I f t h e
i n f e c t i o n p e r s i s t s , a n o p e r a t i o n c a l l e d a
490
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