Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

William S. Halsted, MD

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at  www.nih.gov


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Buccal fat pad by Otto Placik (Own work) CC BY-SA 3.0 or GFDL via Wikimedia Commons
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The [buccal fat pad] is dense, fatty trigone-shaped pad that is located in the cheek. It is formed by several connective-tissue encapsulated smaller fat pads. It covers partially the posterior aspect of the buccinator muscle, and is found deep to the anterior portion of the masseter muscle. Also known as “Bichat’s fat pad”, it was first described by Marie-François Xavier Bichat in 1802. It is also known as the suctorial fat pad and it helps in the suction process for breast feeding in infants, although because of its location it is also said to help in the gliding motion of the masticatory and facial expression muscles. The buccal fat pad is well developed in newborns and is not as evident in most adults.

Its anatomical description varies according to the authors, but it has a main body and three extensions, namely the anteromalar (anterior), pterygomaxillary (pterygoid), and temporal (posterotemporal) extensions. The blood supply to the buccal fat pad is by way of the anterior deep temporal, buccal, and posterior superior alveolar arteries.

Excessive development of this fat pad can lead to cosmetic surgery to eliminate, or at least reduce its size. This procedure is known in many countries as a “bichectomy”, Bichatectomy” of “cheek reduction surgery”, in some cases this procedure can be performed intraorally.

The buccal fat pad can also be used in maxillofacial reconstructive surgery, as well as the repair of skull base defects. When dissecting the buccal fat pad, care must be taken because of the relation of this structure with the parotid duct, the parotid gland, and branches of the facial nerve

Sources:
1. “Anatomy of the buccal fat pad and its clinical significance” Jackson, IT Plastic and Reconstructive Surgery, 06/1999, Volume 103, Issue 7
2. "A review of the gross anatomy, functions, pathology, and clinical uses of the buccal fat pad" Yousuf, S et al Surg Radiol Anat (2010) 32:427–436
3. "The Endonasal Endoscopic Harvest and Anatomy of the Buccal Fat Pad Flap for Closure of Skull Base Defects" Markey, J et al The Laryngoscope 125: 2247-2252
4. "Bichectomy or Bichatectomy - A Small and Simple Intraoral Surgical Procedure with Great Facial Results" Eber Luis de L S. Adv Dent & Oral Health. 2015; 1(1): 555555. DOI: 10.19080/ADOH.2015.01.555555.
5. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain

ImageBy Otto Placik (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons] Click here for the link to the original image