Benica Marie Sun Gonzales BSN3B Group 2 June 19, 2018

What to know about a Schatzki ring One possible complication of a Schatzki ring is food
bolus obstruction, or "steakhouse syndrome." This
involves a ball of food completely blocking the
A Schatzki ring is a circular band of mucosal tissue esophagus, often because it has not been
that can form at the end of the food pipe closest to thoroughly chewed.
the stomach. The ring of tissue causes the food
A food bolus obstruction can cause severe chest
pipe, or esophagus, to narrow.
pain, and it is considered a medical emergency.
Treatment involves a doctor pushing or pulling
away the ball of food using an endoscope, which is
When a ring forms, a person may have no a long, flexible tube.
symptoms. Or, they may have difficulty swallowing,
which the medical community calls dysphagia. The
difficulty may get worse when a person eats dry
bread or meat.
Causes
Doctors are not sure why some people develop a
Schatzki rings are not cancerous, and they are
Schatzki ring.
usually harmless. Changing the diet and patterns of
eating can help with symptoms. The condition can run in families. In others, a
Schatzki ring forms in response to irritation caused
by acid reflux or gastroesophageal reflux disease
Signs and symptoms (GERD).

Symptoms of Schatzki rings may include difficulty

swallowing solid food and a sensation of food
Diagnosis
being caught in the throat.
A doctor will first ask about a person's symptoms
Many people with Schatzki rings experience no
and perform a physical examination. The following
symptoms. Others usually start to notice
tests can help the doctor to confirm the presence
symptoms after the age of 25.
of a Schatzki ring:
Upon examination, a doctor may find that the
1. An X-ray with a barium swallow. This involves
diameter of the esophagus, which is normally
a person swallowing a pill containing barium
around three-fourths of an inch, is reduced to half
contrast dye, which coats the lining of the
an inch.
esophagus, making the X-ray image clearer.
Those with symptoms may notice the following: Around 6–14 percent of these tests show
evidence of a Schatzki ring.
 difficulty swallowing solid foods
2. Endoscopy. In this procedure, a doctor inserts
 dysphagia that comes and goes a narrow tube containing a camera into the
 a sensation of food being caught in the throat esophagus. The camera sends images that help
or chest a doctor to see whether there is an
obstruction, such as a Schatzki ring.
 heartburn.
Symptoms are usually more severe when the ring
is large and resulting in more pronounced Treatment and recovery
narrowing of the food pipe. Treatment is not always necessary if a person
Sipping water between bites and chewing food experiences no symptoms. Many people avoid
thoroughly can make swallowing easier. symptoms by chewing food thoroughly and taking
sips of water between bites.
Benica Marie Sun Gonzales BSN3B Group 2 June 19, 2018

If a person tries these techniques but still has

trouble swallowing, certain procedures can widen
the diameter of the food pipe, making it easier to
swallow.

Possible treatments include:

 Inserting an endoscope into the esophagus
and using a blunt-tipped instrument called a
bougie to widen the Schatzki ring.
 Inserting a tiny balloon into the esophagus and
inflating it to widen the ring, in a process
called balloon dilation. People with difficulty
swallowing often find relief soon after
undergoing this procedure.
 Because many people with Schatzki rings also
experience symptoms of GERD, acid
suppression therapy can help.
 In rare cases, a doctor will recommend
surgically widening the food pipe.

A person can try to reduce acid reflux by:

 avoiding trigger foods, such as caffeine, coffee,
and chocolate
 avoiding spicy and particularly fatty foods
 quitting smoking
 reducing stress
 losing weight if overweight
 changing medications that may be causing
symptoms
Benica Marie Sun Gonzales BSN3B Group 2 June 19, 2018

Broken Jaw (Mandible Fracture) Facts

A broken jaw (or mandible fracture) is a common
facial injury. Only the nose is broken more
frequently. A broken jaw is the 10th most common
fractured bone in the human body. Fractures
(breaks in the bone) are generally the result of a
direct force or trauma to the jawbone (mandible).
A dislocated jawbone means that the
temporomandibular joint (where the jaw connects
with the skull) is moved out of place. The jawbone
may or may not be fractured, but even if there is
no fracture, symptoms (listed below) may be
similar to a jawbone fracture. Temporomandibular
joint (TMJ) dislocation and syndrome is a topic of
another article.
 The jawbone, or mandible is the largest and
main bone of the lower part of the face.
Figure 1 shows the various anatomic
regions of the mandible viewed from the
right side. The anatomic region helps to
classify the location of the fracture while
Benica Marie Sun Gonzales BSN3B Group 2 June 19, 2018
the terms listed below describe the type of Although a jawbone fracture may occur from many
fracture: pathological causes (for example, cancer, bone loss
through infections), the large majority of fractures
o Simple or closed: The fracture did
occur from the following:
not cause a break in the skin or
 Motor vehicle accidents
mucosa or periodontal membrane.
There is no connection between the  Assaults (facial trauma)
jawbone and the environment.
 Sports-related injuries (boxing, football)
o Compound or open: The jawbone is
 Falls (face-first falls)
open to the environment.
The majority of mandibular (jawbone) fractures
o Comminuted: The jawbone region
occur in young adult males (20-30 years of age),
has bone splinters or crushed bone.
with most occurring in the body, condyle, and
o Greenstick: One section of the angle areas of the jawbone.
jawbone is fractured while the other Broken Jaw Symptoms
part is bent. In the majority of patients, the signs and symptoms
of a jawbone fracture begin to develop
o Pathologic: fracture due to
immediately after some trauma to the jaw.
preexisting bone disease
 The most common symptom is jaw pain.
o Multiple: two or more distinct
 People may feel that your teeth do not fit
fractures of the jawbone
together correctly (this is called a
o Impacted: One section of bone is malocclusion). They may be unable to open
driven by force into another section. their jaw all the way, have problems
speaking or chewing food, or notice
o Atrophic: fracture due to bone swelling or displacement of the jaw.
atrophy
 The chin or lower lip may be numb because
o Indirect: fracture in a bone located of damage to a nerve that runs through the
away from the injury site mandible.
o Complicated (complex): fracture  Inside the mouth, bleeding or change in the
with additional tissue or structural normal lineup of teeth or both can be signs
injury of a broken jaw. There might also be
Consequently, linking the anatomical region with bruising under the tongue or even a cut in
the fracture type describes the fracture of the jaw the ear canal due to movement backward
(for example, a comminuted compound fracture of of the broken jawbone.
the body and alveolus of the mandible).  Drooling and the inability to close the
 Men are about three times more likely than
mouth may occur.
women to sustain a broken jaw. Those aged
from about 20-30 years are the most Broken Jaw Exams and Tests
common group affected. About 42% of A doctor will conduct a physical exam and order
jawbone fractures occur only on one side of X-rays if indicated. No blood tests are needed
the jaw. unless there are underlying health problems
suspected that may have played a role in the
 A large percentage of patients with trauma (for example, falls due to medical problems)
jawbone fractures had associated injuries or if you need to go to the operating room to have
to one or more of the following: head, neck, the fracture fixed.
face, eyes, and nose.  The physical examination would consist of a
Broken Jaw Causes general inspection of the face for obvious
deformity, bruising, or swelling. The next
Benica Marie Sun Gonzales BSN3B Group 2 June 19, 2018
step would begin with feeling the jawbone across the fracture site and screws to
through the skin. attach the plates (or thin perforated bars)
to bone may allow some patients to have
 The doctor will check the movement of the
normal motion of the mandible and to eat
mandible. Once the external exam is
shortly after surgery.
complete, the doctor will check inside the
mouth. Patients will be asked to bite down,
and their teeth will be assessed for
alignment.
 The doctor will check the jawbone for
stability. With the straight blade test, the
doctor may place a tongue blade (tongue
depressor, a flat wooden stick) between the
upper and lower teeth and evaluate
whether the patient can hold the blade in
place.
 The best screening film is the panoramic
mandibular X-ray, an X-ray that covers
completely around the jawbone. This type
of X-ray is not often available in smaller
hospitals, so other views are substituted. If
the initial X-rays are negative, a CT scan
may be indicated if the doctor suspects the
patient has a broken jaw but no fractures
visible with initial X-rays.
Broken Jaw Treatment and Surgery
Many people who have jaw pain will not have a
jaw fracture and will be treated with pain
medications and instructions to eat a soft diet and
to follow up with their doctor.
 Those people with fractures require further
evaluation. Many fractures of the jawbone
are associated with gum problems or tissue
damage and should be considered open
fractures. They will be treated with
antibiotics and likely will require surgical
intervention or wiring teeth together.
 People may receive a tetanus shot.
 Pain should be addressed and managed
effectively by the doctor.
 Many mandible fractures are stable, and
the only treatment required is wiring the
upper and lower teeth together. This will
most commonly be performed by an oral
and maxillofacial surgeon.
 More unstable fractures often require
surgery. Surgical methods using plates