Can Surgery Fix My Cleft Nasal Deformity?

Updated on May 30, 2024 | Your Health

Patients with cleft lip with or without cleft palate undergo reconstructive surgery early in life—but a majority will need further surgery to address the resultant functional and aesthetic deformity of the nose that becomes evident over time.

Cleft rhinoplasty can address these issues, resulting in a more symmetric, aesthetically balanced nose with improved breathing. Cleft rhinoplasty is similar to a traditional rhinoplasty in that it can improve the form and function of the nose. However, this is a much more complicated procedure due to the altered anatomy and scarring from prior interventions, which is why it is important to find a surgeon with the right experience.

Christopher R. Razavi, MD. Call 212-241-9410 or click here to make an appointment.

Christopher R. Razavi, MD, Assistant Professor, Division of Facial Plastic and Reconstructive Surgery, Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, explains what you should know before undergoing this complex surgery.

What is cleft rhinoplasty?

Cleft rhinoplasty is a nasal reshaping surgery that essentially addresses form and function issues with the nose resulting from a cleft lip—a congenital defect that occurs in approximately one out of every 1,000 births. This defect most commonly presents unilaterally (on one side of the nose), but it can also be bilateral.

When do patients typically undergo this surgery?

Patients with cleft lip with or without cleft palate generally undergo several surgical repairs during infancy, which start approximately 10 weeks after birth. Cleft rhinoplasty is typically the final procedure in the series of repairs, and it is typically performed between the ages of 15 and 17.

In what cases might someone decide not to get cleft rhinoplasty?

There are cases where the primary rhinoplasty—performed at the initial time of cleft lip repair—results in a nose that looks good enough and works well enough that patients decide not to undergo the definitive cleft rhinoplasty because they are happy with how things are.

How can cleft rhinoplasty help me?

Cleft rhinoplasty can address a wide range of issues related to a cleft lip with or without cleft palate, resulting in:

  • A more symmetrical nose
  • A more even, slim, and better defined nasal tip
  • Increased nasal tip projection
  • Increased nose length
  • A smoother, better shaped nose
  • Enhanced ability to breathe through the nose

Am I a candidate for cleft rhinoplasty?

An evaluation with an expert in facial plastic surgery is a good way to determine if you are a suitable candidate for cleft rhinoplasty. We typically look at physical, functional, and psychologic factors to assess the situation and determine how best to proceed.

There are some patients who have undergone multiple prior rhinoplasties that might make the procedure more challenging. But generally, the contraindications are the same as those for a conventional rhinoplasty, such as a medical comorbidity or instances where the patient’s goals are not realistic.

What happens during the cleft rhinoplasty?

You will undergo general anesthesia, so you will be fully asleep throughout the procedure. While there are several techniques than can lead to favorable outcomes, my team takes a specialized approach that involves using scarred skin from the prior cleft lip repair to enhance the shape and function of the nose. We reposition this scarred skin into the nose, which helps address the relative lack of internal nasal lining on the cleft lip side, and also allows us to revise the cleft lip scar. In this way, we simultaneously improve the appearance of both the nose and the lip scar, while also reducing the need to harvest as much grafting material from other areas of the body.  That said, additional grafting material from the rib is typically needed in these cases. This results in an additional incision on the chest.

Why is cleft rhinoplasty challenging?

The degree of scarring from the previous surgeries and the original congenital abnormality often lead to significant asymmetry in the nose. One of the biggest challenges of performing a cleft rhinoplasty is achieving perfect symmetry, particularly when viewing the nose from the base view, or looking up from below the nose. Although we are able to achieve a more natural and symmetrical look for patients using this unique approach, we also take care to set your expectations for outcomes.

Our goal is for improvement, not perfection, but these are things that are applicable to rhinoplasty in general. Ultimately, as much as our focus is on achieving the best possible outcomes for form, we also need to make sure the nose is functional and that the patient’s nasal breathing is optimized.

What should I expect following surgery?

Patients who have undergone cleft rhinoplasty are typically discharged the same day as surgery and advised to take a week off from work or school. To ensure the repair is protected and heals well, we use both external and internal nasal splints to support healing and aid in recovery. We will see you one week post-surgery to remove the splints and assess how well your nose is healing and functioning. Though most patients can return to regular activities two weeks post-surgery and contact sports after six weeks, we advise you to avoid activities that put your nose at risk.

How long will it take to heal?

It can take up to one year for swelling around the nose to completely subside, meaning that the overall improvements to the appearance of the nose may take time to fully appreciate. Despite that, patients who undergo cleft rhinoplasty from an experienced surgeon will likely be satisfied with the outcomes. Whether you want to breathe better, look better, or both, we are here to help make that happen for you.

What Is the Best Sunscreen and Skincare Routine for Me?

May 21, 2024 | Dermatology, Your Health

As spring turns into summer, people become more aware of protecting their skin from environmental factors like the sun and pollution. However, taking care of your skin and finding the right sunscreen is important to consider year round.

Helen He, MD. Click here to find a dermatology specialist at Mount Sinai.

In this Q&A, Helen He, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, discusses how to build a solid skincare routine and the importance of sunscreen.

Should you change your skin routine as the weather changes?

The foundation for a good skin routine, which includes a cleanser, moisturizer, and sunscreen during the day, is constant year-round. However, there are adjustments you can make as the weather changes.

Because the cold air in the winter can dry out your skin, hydration is key, so you might want a rich, creamy cleanser and a thicker moisturizer rich with glycerin and ceramides to protect the skin barrier. In the summer, sweat and oils build up and cause the skin to be more prone to acne breakouts. To adjust, switch to a gel-based cleanser or even a cleansing oil to remove extra oils and a more lightweight moisturizer that won’t clog your pores.

What are the steps to a good daytime and nighttime skin routine?

The first step for both daytime and nighttime routines is to wash the face with a gentle hydrating cleanser to remove excess oils and dirt that may have accumulated during the day or night. Afterwards, some patients may opt for toners, serums, and eye creams. While this step is optional and should be kept simple, there are active ingredients that can be helpful.

For example, vitamin C serum during the day can brighten your complexion and has antioxidant benefits, while retinol/retinoids in the night can help with skin anti-aging, texture, pigmentation, and acne. If your skin is sensitive, add these ingredients to your routine gradually, and with guidance from a dermatologist.

The next step is to use a moisturizer to seal in the water content and keep the skin hydrated. During the daytime, sunscreen is also critical, and you can opt for a moisturizer that contains sunscreen to simplify your routine.

What is the most forgotten skincare step you see in patients?

Patients think sunscreen is only for the summer, but it is important to wear sunscreen year round. Also, many patients apply sunscreen diligently on their face but neglect other sun-exposed areas like the neck and the back of the hands. Equally important, sunscreen needs to be reapplied every two hours, and even more frequently after exercising and/or sweating.

How important is wearing sunscreen daily?

Daily sunscreen is very important. UV radiation has many harmful effects, from sunburns in the short-term to long-term consequences of cumulative exposure, such as increased risk of skin cancer, premature aging and wrinkles, and other issues with skin dyspigmentation and texture.

How do you choose the best sunscreen?

Use a broad-spectrum tinted sunscreen, which covers UVA, UVB, and visible light. For most patients, sun protection factor (SPF) of 30 or higher is recommended, but if you are particularly sensitive to the sun, have a history or high risk of skin cancer, or have skin concerns like rosacea or melanoma, SPF 50 may be better. While both mineral and chemical sunscreens are effective, mineral sunscreens tend to be broader spectrum and less sensitizing.

If you are active outdoors or swim, water-resistant sunscreen is best. Remember to reapply it frequently.

What cosmetic dermatology treatments do you recommend for aging?

As you age, consider incorporating anti-aging and antioxidant ingredients into your skincare regimen such as vitamin C, niacinamide, and retinoids. With consistent use, these ingredients can help to improve skin complexion and texture, reduce wrinkles, and promote collagen production. You can also explore elective procedures such as lasers and other energy-based devices that resurface and tighten skin, neurotoxins (e.g. Botox®), and soft tissue filler augmentation.

Do I need a complicated skincare routine?

Consistency and simplicity are key. The best cleanser, moisturizer, and sunscreen is the one you will use consistently. Having a complicated skincare regimen with many steps is not necessarily better and can do more harm than good. If you do introduce a new product to your skincare regimen, you should introduce it slowly, perhaps starting out with a few times a week and gradually increase the frequency to daily. Also, only introduce one new product at a time so that if you do get a reaction, you can more easily identify the culprit.

Learn more about Dermatology at Mount Sinai and Find a Doctor

Why It’s Important for AAPI Communities to Be Vigilant About Breast and Colon Cancer Screening

May 8, 2024 | Diversity and Inclusion, Featured, Your Health

As the country celebrates the cultural diversity of Asian Americans, Native Hawaiians, and Pacific Islanders in May for Asian/Pacific American Heritage Month, it is time for a reminder for members of those communities to keep up with their cancer screenings. Specifically, experts at the Mount Sinai Health System are calling on Asian American and Pacific Islander (AAPI) people to be vigilant about breast and colorectal cancer screenings.

“Breast cancer is the leading cause of cancer death for women worldwide, and the second leading cause of cancer deaths for women in the United States,” says Desiree Chow, MD, Assistant Professor of Medicine (General Internal Medicine) at the Icahn School of Medicine at Mount Sinai. “However, for Asian Americans and Pacific Islanders, these groups have been found to consistently score lower than their non-Hispanic white counterparts for breast cancer screening.”

A similar theme echoes in colorectal cancer, notes Sanghyun (Alex) Kim, MD, Chief of Colon and Rectal Surgery at Mount Sinai Beth Israel, Mount Sinai-Union Square, and Mount Sinai Morningside. “Not only are we seeing lower screen rates for AAPI communities in colon cancer, but over the last 20 years, we’ve seen a twelvefold increase in colon cancer rates in these populations,” says Dr. Kim. “This is why it’s very important for physicians who see AAPI patients to be proactive in reminding them to be screened regularly.”

Left: Desiree Chow, MD. Right: Sanghyun (Alex) Kim, MD.

What are the disparities in cancer screening rates among different races/ethnicities?

While breast and colorectal cancer screening rates have steadily grown over the years, Asian American and Pacific Islander (AAPI) populations screen at a lower rate than the non-Hispanic white population. Here’s a snapshot of how each group screens for those cancers from 2008 to 2018, according to a report from the Centers for Disease Control and Prevention (CDC).


Source: Health, 2019, National Center for Health Statistics, CDC

As the COVID-19 pandemic hit, screening rates declined in 2020—by as much as 97 percent for breast cancer for AAPI communities compared with the previous five-year average, according to an April 2023 memo from the CDC. To address the decline in screening among certain populations, the agency is partnering with health care providers to resume timely use of preventive tests for early detection of breast, cervical, colorectal, and lung cancers.

Drs. Chow and Kim share their thoughts on the importance of being up to date with breast and colorectal cancer screenings, respectively.

Why are we calling for our AAPI communities to be vigilant about breast and colorectal cancer screening?

Dr. Chow: In general, Asian American women tend to have dense breasts, which is an independent risk factor for breast cancer and it decreases the ability for mammograms to detect small lesions. So in addition to the higher risk, Asian Americans having lower rates of screening, which is concerning and needs to be addressed.

Dr. Kim: Some 20 years ago when I went into colorectal surgery, the number of surgeries for colorectal cancer for Asian Americans was lower than for their white, Hispanic, or Black counterparts. Since then, that number has increased 12 times—not 12 percent—in America. On top of that, AAPI individuals are known to be less up to date on colorectal screening. Part of it could be a greater focus on other kinds of cancers—such as stomach and liver—instead, and part of it could be attributed to a tendency to play down illnesses and not be very good at following up with doctors.

Who should be thinking about screening? How often should it be done?

Dr. Chow: The United States Preventive Services Task Force (USPSTF), the body that sets guidelines for screening in the country, has recently updated their recommendation for women to start screening for breast cancer at the age of 40, every two years. However, there are other factors that could push one to start screening earlier or screen more frequently, and that is a conversation to have with a health care provider. These could include having a family history of breast cancer or having a genetic predisposition to breast cancer, such as a BRCA gene mutation.

Dr. Kim: The USPSTF recommends screening for colon cancer as early as the age of 45. Colonoscopies are the gold standard and would only have to be done every five to ten years. There are stool-based tests, which would have to be done every one to three years to provide comprehensive detection. This recommendation is the same for both men and women, although men have a higher prevalence of colon cancer. If a patient has a family history of cancer—could be of various types, including pancreas, stomach, liver, breast, endometrial or bladder—that person should consider early screening as well. A simple guideline would be: whatever age the family member had the cancer, the patient’s screening should be done at an age 10 years below that—thus for a patient whose family member had pancreatic cancer at age 50, the patient should get a colonoscopy at age 40.

What is involved in breast and colorectal cancer screenings? Is it painful/time-consuming?

Dr. Chow: The mammogram is the only screening method that has been shown to decrease mortality related to breast cancer. The best way to get a mammogram would be to get a referral from your primary care provider, or your OB/GYN. Under the Affordable Care Act (ACA), public and private insurance must provide preventive women’s health screening with no cost sharing. For those who do not have health insurance, there are ways to obtain low- or no-cost mammograms, as New York City and New York State have programs, such as free mammogram buses, that provide such screening.

The procedure itself is pretty simple, and a technician helps the patient position their breast in a machine that takes images of the breast tissue. Most women do not report significant pain—perhaps some discomfort as they might have to hold certain positions for imaging. But from start to finish, a patient could be in and out of the clinic in about 30 minutes.

Patient service representative Monet Douglas at the Mount Sinai Mammogram Screening Unit Truck

Want to learn more about mobile mammogram services from Mount Sinai? Click to learn more.

Dr. Kim: For stool-based tests, such as Cologuard®, a patient sends a stool sample to a lab, where it’ll be studied to see if it contains blood products and/or polyp components. However, such tests might miss some polyps, hence a need to do them more frequently. A colonoscopy, in which a tube with a camera is put into the rectum and colon, can not only discover polyps and cancerous tumors, but also treat and remove them. Under the ACA, colorectal cancer screening must be covered by public and private insurance without cost-sharing.

A colonoscopy does involve some preparation. The patient is instructed not to eat for about half a day, and to take a concoction that would rinse out the bowels. For the actual procedure, the patient is put to sleep and the doctor would examine the colon and rectum for polyps or signs of cancer. If polyps are removed, or cancer tumors are biopsied, there might be some pain or bleeding afterwards, but for most patients, colonoscopies are very well tolerated. The actual procedure itself takes about 30 minutes, although a patient might take an hour to recover after the exam.

What might be the consequences for not being vigilant about breast and colorectal cancer screening?

Dr. Chow: Missed breast cancer is the biggest consequence. By the time women feel a lump in their breast, the cancer is at a later stage, is harder to treat, and may have already spread to other parts of the body. The point of screening is to detect these cancers at an early stage, when they are still easily treatable and even curable. At an early stage, a patient is more likely to be offered breast conserving surgery, where only a portion of the breast is removed, rather than a mastectomy, where the entire breast is removed.

Dr. Kim: The thing about colon cancer is that it is a preventable cancer. If you can screen and detect signs before it presents as colon cancer, you can avoid more intensive treatment. When the cancer has penetrated into deeper layers of the colon, the surgery needed means you’ll lose more length of colon. If the cancer has advanced even more and spreads out of the colon, you will need not only surgery, but chemotherapy and radiation, and these are very intense on the body. For patients who get rectal cancer—that risk is higher for smokers—if not picked up early, there’s a chance to lose the anus, and that could mean needing a colostomy bag—a pouch in which stool comes out of the abdominal wall.

Any other advice for our AAPI communities to stay on top of their cancer screening?

Dr. Chow: I’ve noticed that some segments of the AAPI population might be less willing, or less able, to access health care. They should still try to form a close relationship with a primary care doctor, so that the doctor is aware of their risk factors and can advise them accordingly. For Asian Americans specifically, there’s a misconception that Asian women don’t get breast cancer as frequently. That’s not so true anymore, as the incidence of breast cancer has been steadily rising since 2000. And lastly, there’s a misconception that if a patient leads a healthy lifestyle, with no family history of breast cancer, they won’t get it. That’s great in that they’re at lower risk, but the majority of breast cancer cases are de novo, meaning the mutation happens for reasons we don’t know. If you meet the guidelines for breast cancer screening and have not done it, do seek it out as soon as you can.

Dr. Kim: I’ve noticed among my Asian patients that the cultural tendency of not wanting to speak up about pain or discomfort is actually working against them for their health. Keeping concerns to yourself hinders proper care. Another thing I’ve noticed is that some—usually older, immigrant individuals—trust their doctors too much and expect their doctors to know and handle everything, while others—sometimes younger, American-born individuals—don’t trust their doctors enough, might have a distrust of the system, or believe they know their body better than the doctor does. Either extreme is not good. The solution to break through to both is patient education and building trust. First, getting information out there about why cancer screening is important helps patients understand the risks. Then, the primary care doctor needs to build a close relationship with the patient, so that the patient actually goes to the screening, but just as importantly, trusts the doctor enough to come back for any follow-ups.

What Is the Difference Between Hepatitis C and Hepatitis B?

May 2, 2024 | Featured, Your Health

Hepatitis is inflammation of the liver—an organ we depend on to digest nutrients, filter blood, and overcome infection. There are many different types of hepatitis, including hepatitis A, B, C, D, and E, with symptoms that include fever, abdominal pain, nausea, jaundice (yellowing of the skin and eyes), and fatigue.

However, most people with chronic viral hepatitis do not experience any symptoms and often do not know they have the infection even while it silently damages their liver. Hepatitis B and C are among the most common types of hepatitis. While they both affect the liver, they are very different.

Douglas Dieterich, MD

In this Q&A, Douglas Dieterich, MD, Professor of Medicine (Liver Diseases) and Director of the Institute for Liver Medicine at the Icahn School of Medicine at Mount Sinai, explains the differences between hepatitis C and B, how they are transmitted and treated, who is at risk, and more.

What is the difference between hepatitis C and B?

Hepatitis C virus (HCV) and hepatitis B virus (HBV) are vastly different viruses. Hepatitis B is highly contagious through sex, using drugs with shared straws and needles, blood transfusions, and even saliva, which can put people living in the same household at risk. The good news is hepatitis B is entirely preventable with a vaccine, which has been around since 1991. The Centers for Disease Control and Prevention now recommends universal vaccination for hepatitis B for all adults under 60 who did not get vaccinated by their pediatrician starting in 1991. People over 60 can also request the vaccine and should, especially if they have ongoing risk factors. If people do get hepatitis B, there are very good drugs to control it and to suppress the virus down to zero so it doesn’t do any damage or infect others. We also have exciting clinical trials happening to study medications that can cure Hepatitis B.

Currently, there is no vaccine for hepatitis C, which is a different class of virus. It actually belongs to a class that you may have heard of—West Nile virus, dengue fever, yellow fever, and Zika, which has been in the news the last few years. None of those become chronic, however, while hepatitis C does. Over time, it can cause the same liver damage that hepatitis B can, including liver cancer, which can lead to death. The good news is, it’s now easily curable.  We have fantastic new drugs for hepatitis C—most patients need to take only 8 to 12 weeks of easy-to-take pills with virtually no side effects and a 99 percent cure rate. It’s absolutely important to find out if you have hepatitis C or B because we can cure hepatitis C and control hepatitis B.

What do I need to know about hepatitis D?

Hepatitis D, also known as hepatitis Delta virus (HDV), is the most severe form of viral hepatitis. This is a type of hepatitis that can only infect people who have hepatitis B. Approximately 70 percent of people who have hepatitis Delta will develop cirrhosis (liver scarring) within 5 to 10 years of infection. This is a much higher and faster progression than for most people with hepatitis C and hepatitis B.

Hepatitis Delta can only function in a body that is also infected with hepatitis B. Not everyone with hepatitis B has hepatitis Delta, but everyone with hepatitis Delta also has hepatitis B. That’s why we recommend everyone with hepatitis B get screened for hepatitis Delta too.

New effective treatments for hepatitis Delta are coming soon and are already available to some patients, depending on their specific health situation. Our providers can screen you for hepatitis Delta and help get you onto treatment if needed.

Who is at risk for contracting hepatitis B and C, and who should get screened?

The CDC recommends all adults be screened for hepatitis B and C at least once in their life, even if they don’t think they have any risk factors. Many people have been exposed but don’t know it. The major method of transmission for hepatitis B, globally, is from mother to infant at birth. Other people who are at risk are those who have never been vaccinated—primarily people born before 1991—and we see that happening now. When people born before 1991 come in contact with people who have hepatitis B, they can catch it quite easily. Hepatitis C is more difficult to catch. The major risks for hepatitis C are having had a transfusion of blood or blood products, such as gamma globulin, before 1992, or using IV drugs or intranasal drugs. Just snorting drugs with a straw is enough to spread Hepatitis C. People who have unprotected sex—especially men who have sex with men—are also at risk for hepatitis C. It’s very important to get diagnosed early so you can get treated and cured. If you know you have ongoing risk factors, you should be screened at least once a year.

Why is hepatitis more common in New York City?

About 48 percent of the people who live in New York City were born outside of the United States. Many of those people come from countries where hepatitis B or C is endemic, and that’s the major risk factor for hepatitis B. Endemic means that a high percentage of people in an area have the disease and therefore the risk of getting the disease is high. The New York City Department of Health and Mental Hygiene estimates that 243,000 New Yorkers, or 2.9 percent of the population, have chronic hepatitis B. The Department also estimates that approximately 86,000 New Yorkers, or 1 percent of the population, have chronic hepatitis C.  If we catch viral hepatitis early, we can help you prevent liver scarring and liver cancer.

What is the best way to prevent hepatitis B and C?

The best way to prevent hepatitis B is to get vaccinated for hepatitis B. The CDC now recommends everyone aged 18 to 59 be vaccinated for hepatitis B. If you weren’t vaccinated as a kid, it’s easy to check if you have antibodies to hepatitis B, or if you have hepatitis B, we can treat that. Ask your doctor about testing and vaccination.

Hepatitis C is mostly spread blood to blood. Shared needles—if you’re using IV drugs, and shared straws if you’re using intranasal drugs—things like that—are really high risk for spreading hepatitis C. Getting a tattoo or piercing from an unlicensed technician may also put you at risk if they are not properly cleaning their needles. If you are using drugs, don’t share needles, don’t share straws. And get tested for hepatitis C, because if you have it, we can cure it. Once cured, you can become reinfected with hepatitis C, so it’s very important to continue avoiding infection after getting cured, which means not sharing needles or straws and practicing safe sex, and only getting tattoos and piercings from licensed technicians.

What resources are available at Mount Sinai for screening and treatment of hepatitis?

We have numerous resources dedicated to screening and treatment of hepatitis B and hepatitis C at Mount Sinai. We’re the largest independent liver program in the country. We have liver clinics all over Manhattan and the metropolitan area—from Long Island to Westchester.  Our care coordinators will support you from screening through treatment and cure, working closely with your provider to ensure you get the best care.

Is the Sore in My Mouth an Oral Lesion?

Updated on May 2, 2024 | Dental and Oral Health, Ear Nose Throat, Your Health

Have you noticed a wound in your mouth that is not healing? Maybe you also noticed it has a bump or area that seems unnaturally firm to the touch? If these symptoms sound familiar to you, you may have an oral lesion.

Mohemmed Nazir Khan, MD

In this Q&A, Mohemmed Nazir Khan, MD, an Assistant Professor at the Department of Otolaryngology at Mount Sinai-Union Square and a surgeon at Mount Sinai’s Head and Neck Institute—Center of Excellence for Head and Neck Cancer, explains the importance of detecting oral lesions early. While regular dental appointments are important, anything that looks or feels suspicious should be checked out immediately.

“Even if it turns out to be nothing, it is better to be safe than sorry,” he says. “I know the thought of a consultation can be scary, but the earlier we intervene, the better your outcomes will be.”

What is an oral lesion?

An oral lesion is an abnormal cell growth in your mouth, which has the potential to become cancerous. There are several telltale signs that you should look for, including:

  • A cut or sore in the mouth that becomes painful and has an underlying bump. This may be accompanied by bumps on the neck, but they are rare.
  • Unusual white or angry-looking red patches; an ulcerated, or cratered, lesion that is painful.
  • An unusually firm area of your mouth.
  • Numbness or loss of function, such as your tongue deviating to one side when you stick it out.

What is the difference between an oral lesion and a canker sore?

You may mistake some signs of oral lesions for a canker sore, formally known as an ‘aphthous ulcer.’ However, there are several key differences. For one, an oral lesion is not usually painful when it first appears, unlike a canker sore. Also, canker sores tend to be flat, with edges that appear angry and red. Most important of all, a canker sore will usually heal in two to three weeks. An oral lesion will not.

Usually, an oral lesion is easy to spot because it is front and center, such as on the tongue. If you have a wound or area of firmness in your oral cavity that does not get better over the course of a month, you need to have it examined because that is an indicator of an oral lesion.

Oral lesions are not commonly associated with the human papillomavirus (HPV). Furthermore, the signs are similar for both adults and children. However, the lack of risk factors among young people suggests that there is a genetic predisposition at play. This does not rule out environmental triggers, such as scratching from a misaligned incisor. But the hypothesis is that the irritation is the spark that lights the match for the genetic predisposition.

What are the most common types of oral lesions?

There are six different kinds of oral lesions:

  • Oral lichen planus, a chronic inflammation that often appears as white patches on your inner cheek or other parts of your mouth, which has no known cause.
  • Candidiasis, a fungal infection caused by candida, a type of yeast, which often appears as white patches in your mouth with some degree of redness or soreness.
  • Leukoplakia, white patches typically caused by constant injury or irritation.
  • Erythroplakia, which appears as red lesions in the mouth, bleeds when irritated, and is linked to alcohol and tobacco use.
  • Oral cavity cancer, which often appears as a sore or lump on the lips or in the mouth, and is also linked to alcohol and tobacco use.
  • The herpes simplex virus, which often appears as a cluster or a single small painful blister in the mouth, but may also look like a sore.

What should I do if I think I have an oral lesion?

You should make an appointment with a dental professional for a physical examination. In cases where your doctor has a high clinical suspicion of oral lesions, such as angry red patches, a biopsy may be performed, which will be done in the office. This involves numbing the area before removing a small sample for analysis. For patients who present with enlarged lymph nodes, a doctor normally collects a sample using a needle biopsy. The biopsy is invaluable because it establishes the diagnosis so the doctor can proceed with treatment. It also gives us the ability to reassure patients who have a premalignant lesion that just requires monitoring.

In cases involving cancerous or moderate-to-high risk precancerous lesions, doctors may recommend surgical removal. This is typically done using open surgery as most patients present with oral lesions on the tongue. However, at Mount Sinai’s Head and Neck Institute—Center of Excellence for Head and Neck Cancer, we are typically able to remove most oral lesions with few incisions. But we will remove the lymph nodes from the neck on the ipsilateral—or the same side—as the lesion if the tumor has a thickness of four millimeters or more. In cases involving bone structure, such as the jaw or midface, we will remove the lesion in collaboration with oral and maxillofacial surgeons. This allows us to better reconstruct boney structures and also achieve the best outcomes for your dental rehabilitation.

If the diagnosis reveals that the lesion is a stage two or higher cancer, we will recommend radiation therapy post-surgery. We will also recommend chemotherapy if there are positive margins following surgery—meaning that not all of the cancer could be removed—or if there is extranodal extension of the tumor, which means that the cells have spread beyond the lymph nodes.

For tumors that are located low on the tongue, or close to the floor of the mouth, we recommend microvascular reconstruction using skin and fat from other parts of the body. This allows us to preserve essential functions, such as your ability to eat and talk.

What should I expect following treatment?

Recovery differs based upon the extent of the surgery. For example, patients who undergo primary tumor removal without reconstruction are often discharged the same day and are started on a soft diet to promote healing. Patients who undergo lymph node removal are normally discharged the next day with a drain. Patients who undergo bone reconstruction are fitted with a nasogastric tube for a week to promote healing. In all cases, the goal at Mount Sinai is to get you back to eating and drinking as quickly as possible.

After surgery, we consult with patients every two months for the first year and conduct a surveillance scan at three months to ensure that all looks well. If subsequent scans show no signs of lesions, we gradually reduce the number of consultations to once a year after year five.

How can I prevent oral lesions?

You can take several steps to reduce your risk of developing an oral lesion:

  • Maintain a healthy diet
  • Practice proper oral hygiene by brushing and flossing daily
  • Avoid betel nut chewing, which can lead to significant scaring and increased risk for oral cancer
  • See a dental professional twice a year
To make an appointment with Dr. Khan, call 212-844-8775.
Make an appointment with Dr. Khan online.

Can Exercise Improve My Mental Health?

Updated on May 2, 2024 | Mental Health, Psychiatry, Your Health

Exercise is great for your body—and your mind. When you engage in any physical activity, your brain releases “feel-good” chemicals (dopamine, serotonin, oxytocin, and endorphins) that boost your mood. In addition, forming long-term exercise habits can reduce your risk for neurological diseases, such as dementia.

Anna Hickner, PsyD

In this Q&A, Anna Hickner, PsyD, Supervising Psychologist and Assistant Professor, Icahn School of Medicine at Mount Sinai, and a trained yoga and meditation instructor, explains how increasing your activity can lead to a healthier, happier mind.

How does not getting enough exercise affect my mental health?

Leading a sedentary lifestyle can have many adverse effects on your physical, emotional, and mental well-being. Additionally, if you are not sleeping well and don’t move much during the day, this can have a compounding effect of worsening sleep and mood without inducing the benefits of the “feel-good” chemicals that exercise offers. As a result, you may find it harder to function or interact effectively with others.

Quick tips:

  • Creating an exercise routine can help you feel grounded and regulate stress
  • Achieving exercise goals boosts the brain’s reward center and builds self-esteem
  • Even small activities, such as walking during your lunch break, can make a big difference

How does exercise affect my mood?

There has been a lot written on the association between exercise and mental health, including how exercise induces the production of our natural “feel-good” chemicals. But exercise has additional benefits—for example, certain activities, like sports, are great outlets for socializing, and exercise, in moderation and well before bedtime, in general helps regulate sleep. Becoming more active may also motivate you to eat well in order to fuel your body, which can have a positive impact on mood. Some studies indicate people might demonstrate better memory and attention after a workout, which is most noticeable when exercise is consistent and the effects are studied over a longer period.

How can exercise improve my mental health in the long term?

Turning exercise into a routine that helps you achieve goals, such as losing weight or becoming fitter, can be gratifying and help build self-esteem, as long as you have reasonable expectations and stick to your goals. When you complete an activity, such as a race, or compete in a team sport, there can be an extra boost in your neurochemical rewards center, which offers a feedback loop for motivation to continue to engage in the activity. When you do this in moderation, exercise transforms into a habit that provides physical, emotional, and psychological benefits. It is important to find an activity that is enjoyable so you can easily stick with it. Another long-term benefit of exercise is that it is shown to reduce the risk of neurodegenerative diseases, such as Alzheimer’s disease and dementia, due to the stimulation of blood flow in the brain.

How much exercise do I need to get these benefits, and at what intensity?

It is usually better to be active than not. That said, some studies show walking is just as beneficial as running, whereas others find intensity matters. Regardless, a minimum of 150 minutes of moderate to vigorous movement each week is often cited as ideal, as well as the importance of elevating your heart rate.

While intensity can be beneficial, too much may stress your body or lead to injury, so consistency and moderation are important. Having a routine can keep you grounded and helps regulate stress. If intense exercise feels daunting, find an activity you enjoy that gets you moving, and that you can do regularly. You can also combine exercises, such as swimming, dancing, walking, or kick-boxing classes, mixing exercises that are leisurely on some days with more intense ones on others.

What are some simple ways to increase my activity to improve my mood?

Small activities can add up. If you have a desk job, get up and stretch or go for a mini walk every hour or so. Take the stairs instead of the elevator, bike instead of taking the bus or driving, park far away so you have to walk further. These are all examples of small, daily changes that can bring big benefits. You can also try fitness trends, such as “exercise snacks,” in which you do a vigorous activity for as little as two minutes. Whether you lack the time or a place to work out, finding small ways to increase exercise can improve both your health and mental well-being. Exercising outside on a regular basis can also improve your mood.

How does my gut health contribute to my mental well-being?

Gut health is also important for mental health—some research indicates that microbiome and inflammation can affect mood. Consuming food that offers adequate macronutrients (carbs, fats, proteins, water, and fiber) as well as micronutrients (vitamins and minerals) is imperative to feeling energized, meeting the day’s demands, and staying motivated. Increase your consumption of whole foods, limit processed foods, caffeine, alcohol, and sugar, and consult a dietician if you feel you need help.

Schedule an appointment with a mental health expert near you.

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