When SANITAS started in 2012 we found that a great many Tanzanians were requesting specialist surgical services and that many of them were travelling overseas to have their surgeries conducted. This is not ideal, for Tanzania or for the patients. Travelling overseas is expensive, you most likely can't take your loved ones with you, you are sick in a foreign country, and you will be sent back to Tanzania for recovery time in facilities without the expertise you require.

Most small to medium health facilities can't afford to keep these kind of expert surgeons on staff, so we have done the next best thing, which is to invite super surgeons to SANITAS for our patients every 3-4 months. After 5 years of doing this it has become very successful and we have a set of surgeons in different disciplines who visit us regularly. They have performed more than 500 surgeries for Tanzanian's that otherwise would not be possible here at home.
Please see specialities menu below and the surgeons who visit, and the type of conditions they can help you with.



| What is Orthopaedics? | Dr Gautam Kodikal - Orthopaedic Specialist | Dr Shetty - Spinal Specialist |



What is Urology? | Dr Aditya Pradhan - Urological Specialist |



|Dr Subramania Iyer - Reconstructive specialist surgeon |


Other sections coming soon!


| what is ENT? | Dr Suhel Hassan - ENT specialist surgeon |


| What is Gynaecology? | Dr Mussa Musemo - Gynaecologist | Dr J Malembe - Gynaecologist | Dr Josephine Otieno - Gynaecologist |



| Why use a Paediatrician? | Dr Ayam - Paediatrician | Dr Rafia - Paediatrician | Dr Nahida Wali - Paediatrician |
|Paediatric conditions |


Orthopedics is the medical study and specialisation of diagnosis and treatment for conditions of the musculoskeletal system. Most of us think of Orthopedics as just about bones, but it is also about your muscles, and how they work together with your bones and internal systems.

Your musculoskeletal system includes:
> your muscles
> your bones
> the joints of your bones
> the fluids around your bones
> the ligaments that hold your bones together
> and the tendons that connect your muscles to your bones

All very important parts of your body with very important functions!

Your musculoskeletal system is what allows you to move, keeps you upright and stable, allows you to walk, bend, lift, sit, lay down, get up, dance, do yoga, take the stairs, drive, read a book.....

.. all things that we take for granted, until we can't do them. .

Did you know that you have more than 200 bones in your body? AND more than 600 muscles?

This 'musculoskeletal' system is extraordinarily complex. As well as keeping us upright and facilitating movement, the bones and muscles in our body protect our internal organs. Our bones are also a reserve for many different minerals that our body needs to function.

Orthopedic health is vitally important

It is the complexity of our musculoskeletal system that gives us many of the abilities we have. But it is also where even a small problem can cause large consequences.

There are a great many conditions that can affect your musculoskeletal system and severity of affects that is has on your life.

Bones can become brittle, muscles can be strained or stretched, bones can loose strength, muscles can contract, bones joints can loose their fluid lubricant and become inflammed, bones can deform from birth or over time, and the list goes on and on.

Below are some small explanations of a few of the most common conditions that Dr Gautam and our Orthopedic specialists and surgeons can help you with.


Arthritis is a condition of inflammation of the joints between your bones. Arthritis can affect almost any joint in your body. Most commonly it affects hands, hips and knees.

This inflammation may have a few different causes, in fact there are more than 100 different kinds of Arthritis. The inflammation of the joint however is the common factor in them all and all are commonly known as Arthritis.

One of the most common forms of Arthritis is known as OSTEOARTHRITIS.

Osteoarthritis is always associated with the break down or loss of cartilage from the joint. It might be caused by trauma or repetitive use, it could be inherited or also may develop from stress on the joints such as obesity.

Another type of Arthritis is Rhuematoid Arthritis.

Rhuematoid Arthritis is an autoimmune disease, it can attack many different organs including your heart and lung tissues. But the most concentrated affect is on the fluid in your joints. The joints become swollen and warm and very tender. Sometimes there is stiffness after movement or after sleep. Eventually the agitation of the joint fluid will eat away at the bone surfaces and cause damage and further pain.

Most kinds of Arthritis can be diagnosed with medical imaging. Sometimes pain can be managed with medication and sometimes surgical solutions are available to replace the cartilage or the entire joint. Your Orthopedic specialist can advise you on the best course for you.


Neck pain is very common and as we get older it is more likely. More than 50% of the population over 60 years of age will suffer from varying degrees of neck spondylosis. Neck spondylosis is most often a persistent minor pain, irritating, but very rarely develops into any kind of crippling or debilitating pain.

As for any joints, the neck vertebrae over time can wear down, their moisture content becomes less the older we get and the cartilage between the joints can wear out completely. If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth — called spurs — may narrow the space for the nerves to pass through (stenosis).

There are several factors that increase your risk for cervical spondylosis. The following have all been linked to higher risks of neck pain and spondylosis:

Genetics - if your family has a history of neck pain
Smoking - clearly linked to increased neck pain
Occupation - jobs with lots of neck motion and overhead work
Mental health issues - depression/anxiety
Injuries/trauma - car wreck or on-the-job injury

Pain from cervical spondylosis can be mild to severe. It is sometimes worsened by looking up or down for a long time, or with activities such as driving or reading a book. It also feels better with rest or lying down.

Additional symptoms include:
Neck pain and stiffness (may be worse with activity)
Numbness and weakness in arms, hands, and fingers
Trouble walking, loss of balance, or weakness in hands or legs
Muscle spasms in neck and shoulders
Grinding and popping sound/feeling in neck with movement

Cervical spondylosis can be diagnosed with medical imaging and your Orthopedic specialist will likely involve the Physiotherapist in any treatment. Pain can be managed with medications, and physio will help strengthen the neck muscles and reduce the pressure put on individual joints.


If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.

Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, this article will help you understand more about this valuable procedure

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

•Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

•Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis."

•Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

The decision to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopaedic surgeon. Your physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you might benefit from this surgery. When Surgery Is Recommended

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

A knee that has become bowed as a result of severe arthritis.

•Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker

•Moderate or severe knee pain while resting, either day or night

•Chronic knee inflammation and swelling that does not improve with rest or medications

•Knee deformity — a bowing in or out of your knee

•Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Candidates for Surgery

There are no absolute age or weight restrictions for total knee replacement surgery.
Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.


Osteoporosis is a very common disease that weakens your bones. It comes very quietly, slowly slowly weakening your bones from the inside, until one day you experience a fracture or a break. You may not even notice that you have Osteoporosis until this happens.

Osteoporosis occures mostly in older people, or that is when it is noticed, but actually the damage has been done over much time. Most people will not suffer any noticable symptoms until the disease is already well developed and damage is done. Sometimes there may be a small decrease in height, or a slight hump can develop in the spine. But in most cases your first clue is a broken or fractured bone. In very severe cases your bones can become so thin and weak that even a cough or a hug can cause fractures or breaks.

Osteoporosis is an incredibly painful and debilitating disease.

The weakening of the bone is caused by a gradual decline and make up of the mineral content of the bone. But the actual cause of this decline is not well defined, there is not one particular thing that is thought to trigger this weakening of the bones. Age is of course a factor and it can be found more often in women than in men. Excessive alcohol consumption, smoking and malnutrition can be contributors as well as vitamin D deficiency and periods of physical stress. Many other diseases can also contribute to Osteoporosis.

Osteoporosis can be diagnosed with a variety of tests and medical imaging that your Orthopedic specialist will prescribe.


Tendons are the cord like extensions of the muscle that connects muscle to bone. Most tendinitis is a result of a wearing down of the tendon that occurs slowly over time.

Generally, tendinitis is one of two types:

•Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.

•Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.

The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons.

The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.



The tendons are the part of the muscle that joins the muscle to the bone. In a bone joint like the shoulder which has very high mobility and can rotate 360 degrees there are many tendons at work to attach all the required muscles and hold the joint together.

Sometimes ages, some repetitive strain activities or a traumatic injury can cause a tear in the tendon. This can separate the muscle from the bone.

This causes some pain and mostly restrictive movement in that joint.

It is not an uncommon injury, but most severe in older people who are engaged in these kind of activities or have a trauma injury.

If the tear is minor, treatment may include physical therapy and some medications. If the tear is more serious then a surgical solution will be recommended.

Repairing a torn rotator cuff is most often done arthroscopically through several tiny incisions. The surgeon works with small instruments including a miniaturized camera, while looking at the inside of the shoulder on a television monitor.


Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition.

But several other sports and repetitive labour activities can also put you at risk.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow.

The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a team approach.

Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.


Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.

Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis.

Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.

Prepatellar bursitis is an inflammation of the bursa in the front of the kneecap (patella). It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee.

Prepatellar bursitis is often caused by pressure from constant kneeling. Plumbers, roofers, carpet layers, coal miners, and gardeners are at greater risk for developing the condition.

A direct blow to the front of knee can also cause prepatellar bursitis. Athletes who participate in sports in which direct blows or falls on the knee are common, such as football, wrestling, or basketball, are at greater risk for the condition.

Other people who are more susceptible to the condition include those with rheumatoid arthritis or gout.

Prepatellar bursitis can also be caused by a bacterial infection. If a knee injury breaks the skin, such as an insect bite, scrape, or puncture wound, bacteria may get inside the bursa sac and cause an infection.


Almost everyone will experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However it happens, low back pain can make many everyday activities difficult to do.

Back pain is different from one person to the next. The pain can have a slow onset or come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves on its own within a few weeks.

There are many causes of low back pain. It sometimes occurs after a specific movement such as lifting or bending. Just getting older also plays a role in many back conditions.

As we age, our spines age with us. Aging causes degenerative changes in the spine. These changes can start in our 30s — or even younger — and can make us prone to back pain, especially if we overdo our activities.

Back pain varies. It may be sharp or stabbing. It can be dull, achy, or feel like a cramp. The type of pain you have will depend on the underlying cause of your back pain.

Most people find that reclining or lying down will improve low back pain, no matter the underlying cause.

People with low back pain may experience some of the following:

•Back pain may be worse with bending and lifting.

•Sitting may worsen pain.

•Standing and walking may worsen pain

•Back pain comes and goes, and often follows an up and down course with good days and bad days.

•Pain may extend from the back into the buttock or outer hip area, but not down the leg.

•Sciatica is common with a herniated disk. This includes buttock and leg pain, and even numbness, tingling or weakness that goes down to the foot. It is possible to have sciatica without back pain.

Regardless of your age or symptoms, if your back pain does not get better within a few weeks, or is associated with fever, chills, or unexpected weight loss, you should call your specialist.


A spinal tumor is a growth of cells (mass) in or surrounding the spinal cord.

Any type of tumor may occur in the spine, including:




A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas.

Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metastasis) are called secondary spinal tumors. Tumors may spread to the spine from the breast, prostate, lung, and other areas.

The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects.

Spinal tumors can occur:

•Inside the spinal cord (intramedullary)

•In the membranes (meninges) covering the spinal cord (extramedullary - intradural)

•Between the meninges and bones of the spine (extradural)

Or, tumors may extend from other locations. Most spinal tumors are extradural.

As it grows, the tumor can affect the:

•Blood vessels

•Bones of the spine


•Nerve roots

•Spinal cord cells

The tumor may press on the spinal cord or nerve roots, causing damage. With time, the damage may become permanent.

The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.

Tumors in the spinal cord usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord may grow for a long time before causing nerve damage.

Symptoms may include:

•Abnormal sensations or loss of sensation: ◦Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)

◦Cold sensation of the legs, cool fingers or hands, or coolness of other areas

•Back pain: ◦Gets worse over time

◦In any area -- middle or low back are most common

◦Is usually severe and not relieved by pain medication

◦Is worse when lying down

◦Is worse with strain, cough, sneeze

◦May extend to the hip, leg, or feet (or arms), or all extremities

•Fecal incontinence

•Inability to keep from leaking urine (urinary incontinence)

•Muscle contractions, twitches, or spasms (fasciculations)

•Muscle function loss

•Muscle weakness (decreased muscle strength not due to exercise): ◦Causes falls

◦Especially in the legs

◦Makes walking difficult

◦May get worse (progressive)



A herniated disc occurs when one of the small, spongy discs that cushion the vertebrae bulges or breaks open.

This condition, also known as a slipped or ruptured disc, can affect any part of the spine, but is most common in the lower back.

Treatments for a herniated disc include:


•Physical therapy

•Artificial disc replacement

•Spinal fusion


•Microendoscopic discectomy

•Epidural steroid blocks

•Selective nerve root blocks/transforaminal epidural steroid blocks



Degenerative disc disease refers to the normal breakdown of spinal discs as we age. A sudden injury leading to a herniated disc may also begin the degeneration process.

The condition causes back or neck pain, and can lead to osteoarthritis or spinal stenosis. Treatments for degenerative disc disease include:


•Physical Therapy

•Artificial disc replacement

•Spinal fusion

•Epidural injections

•Epidural steroid blocks

•Selective nerve root blocks/transforaminal epidural steroid blocks


Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord.

While the condition can affect any part of the spine, it is most common in the lumbar and cervical regions. Some people are born with stenosis; others develop it as they age.

Treatments for spinal stenosis include:


•Physical therapy



•Spinal fusion

•Interspinous/interlaminar implant

•Epidural steroid blocks

•Selective nerve root blocks/transforaminal epidural steroid blocks


Sciatica is pain, tingling or numbness caused by irritation of the sciatic nerve in the lower back. It can result from a herniated disc pressing against the nerve roots, spinal stenosis, arthritis or an injury-induced pinched nerve.

Treatments for sciatica include:


•Physical therapy


•Spinal fusion

•Epidural steroid blocks

•Selective nerve root blocks/transforaminal epidural steroid blocks

•Sympathetic blocks


Myelopathy is the gradual loss of nerve function caused by disorders of the spine. The condition commonly results from spinal injury or spinal stenosis, a progressive narrowing of the spinal canal.

Myelopathy treatments include:


•Physical therapy


•Spinal fusion


Scoliosis is a lateral curvature of the spine. Instead of the gentle inward and outward curves of a normal spine, scoliosis produces an “S” or “C” shape.

The condition is primarily congenital, but also results from traumatic injury or osteoporosis.

Scoliosis treatments include:

•Physical therapy

•Spinal fusion

•Facet blocks


Osteoporosis is the most common cause of this type of fracture. Osteoporosis is a disease in which bones become fragile. Usually, the bone loses calcium and other minerals.

•Trauma to the back

•Tumors that started in the bone or spread to the bone from elsewhere

•Tumors that start in the spine, such as multiple myeloma

Having many fractures of the vertabrae can lead to kyphosis. This is a hump-like curvature of the spine Compression fractures can occur suddenly. This can cause severe back pain.

•The pain is most commonly felt in the middle or lower spine. It can also be felt on the sides or in the front of the spine.

•The pain is sharp and " knife-like." Pain can be disabling, and take weeks to months to go away.

Compression fractures due to osteoporosis may cause no symptoms at first. Often, they are discovered when x-rays of the spine are done for other reasons. Over time, the following symptoms may occur:

•Back pain that starts slowly, which gets worse with walking, but is not felt when resting

•Loss of height, as much as 6 inches over time

•Stooped-over posture, or kyphosis, also called a dowager’s hump

Pressure on the spinal cord from hunched over posture can, in rare cases, cause:




•Difficulty walking

•Loss of control of the bowel or bladder

Most compression fractures are seen in older people with osteoporosis. These fractures often do not cause injury to the spinal cord. The condition is usually treated with medicines and calcium supplements to prevent further fractures.

Pain may be treated with:

•Pain medicine

•Bed rest

Other treatments may include:

•Back braces, but these may further weaken the bones and increase the risk of more fractures

•Physical therapy to improve movement and strength around the spine

•A medicine called calcitonin to help relieve bone pain

Surgery may be done if you have severe and disabling pain for more than 2 months that does not get better with other treatments. Surgery can include:

•Balloon kyphoplasty


•Spinal fusion

Other surgery may be done to remove bone if the fracture is due to a tumor.


Spondylolisthesis is a condition in which a bone (vertebra) in the spine slips out of the proper position onto the bone below it.

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis) area. It is often due to a birth defect in that area of the spine or sudden injury (acute trauma).

In adults, the most common cause is abnormal wear on the cartilage and bones (such as arthritis).

Bone disease and fractures can also cause spondylolisthesis. Certain sport activities -- such as gymnastics, weight lifting, and football -- put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. This can lead to a stress fracture on one or both sides of the vertebra. A stress fracture can cause a spinal bone to become weak and shift out of place.

Spondylolisthesis may vary from mild to severe. A person with spondylolisthesis may have no symptoms.

The condition can produce increased lordosis (also called swayback), but in later stages may result in kyphosis (roundback) as the upper spine falls off the lower spine.

Symptoms may include:

•Lower back pain

•Muscle tightness (tight hamstring muscle)

•Pain, numbness, or tingling in the thighs and buttocks


•Tenderness in the area of the slipped disc

•Weakness in the legs

If the slippage is not severe, you can play most sports if there is no pain. Most of the time, you can resume activities slowly.
If too much slippage occurs, the bones may begin to press on nerves. Surgery may be necessary to correct the condition.



The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion.

For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.

Neck pain may result from abnormalities in the soft tissues—the muscles, ligaments, and nerves—as well as in bones and disks of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury (a sprain) or prolonged wear and tear.

In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.

If you have prolonged or frequently recurring neck pain, you should seek the assistance of an Orthopedic or Spinal specialist.



The spine of course is part of the Musculoskeletal system and conditions of the spine are included in Orthopedics. However, the spine itself has so much complexity and the severity of spinal conditions can be so debilitating, that specialization in the spine is in itself a very expansive surgical field.

Your spine keeps you upright, allows you to stand, and bend and twist and move around.

Your spine is also the protective unit for your spinal cord. The spinal cord contains all of your nerves running from your brain out into other parts of your body. All of your body parts are important, but a well formed, healthy strong spine is vital to a good quality of life.

Your spine is made up of three segments. These segments form three natural curves. The "c-shaped" curves of the neck (cervical spine) and lower back (lumbar spine) are called lordosis. The "reverse c-shaped" curve of the chest (thoracic spine) is called kyphosis.

The cervical spine is made up of seven small vertebrae that begin at the base of the skull and end at the upper chest.

The thoracic spine is made up of 12 vertebrae that start from the upper chest to the middle back and connect to the rib cage.

The lumbar vertebra consists of five larger vertebrae. These vertebrae are larger because they carry more of your body's weight.

The spinal cord extends from the skull to your lower back and travels through the middle part of each stacked vertebra, called the central canal. Nerves branch out from the spinal cord through openings in the vertebrae and carry messages between the brain and muscles.

Intervertebral disks sit in between the vertebrae. They are flat and round, and about a half inch thick. The Intervertebral disks are the shock absorbers of the spine. Many of the conditions of the spine come from degeneration or malformation of these disks or from the compression of the nerves travelling through these disks.


Dr. Gautam Kodikal is a well known Orthopedic Surgeon from India. Dr Gautam has more than 30 years experience working in different locations around India and the world. He is a life member of the Indian Orthopaedic Association.

He has vast experience in Knee & Hip Replacements and Knee Arthroscopy, and has performed more than 1500 joint replacement surgeries. Three of those knee replacement surgeries have been done right here at SANITAS Mikocheni in Dar es Salaam.

Dr. Kodikal has a broad surgical interest particularly in the areas of Knee & Joint Replacement, Pediatric-Arthroscopic joint preservation and minimally invasive surgery.

More on Dr Kodikal here



Doctors photo

Dr. Subodh M. Shetty, one of India’s most renowned spine and joint surgeon now practices as a senior consultant in Bangalore. He is available for consultations at SANITAS Mikocheni, here in Dar es Salaam.

His work mainly concerns with treatment of disorders of the spine. These conditions include degenerative disorders of the back or neck (disc herniations, stenosis, spondylolisthesis, etc), tumours of the spinal column, infections involving the spine (Tuberculosis etc), osteoporosis of the spine, trauma to the spinal column and developmental problems including scoliosis.

Dr. Shetty is an expert in treating slipped disc problems of the neck and lower back using minimal invasion techniques. He has also been treating paediatric spine problems with hunch back problems.

More on Dr Shetty here



Doctors photo

Dr. Aditya Pradhan is Presently working as a Sr. Consultant in Urology Department at BLK Super Speciality Hospital, New Delhi

He has also been: Consultant in Urology at the prestigious Army Hospital R&R, New Delhi Consultant in Urology at the Military Hospital in Jalandar, Punjab. (Started the Endourology and Laparoscopic Urology programme for this center) Consultant in Urology at the Command Hospital, Lucknow, UP

Set up of the Renal Transplant Programme of this center and successfully conducted 20 renal transplants in 2006-07. In recognition of this was awarded the Chief of Army Staff Commendation card. Was involved in 2 large mass casualty operations in aid to civil establishment of Pithoragarah Distt in Uttarakhand. Was awarded the Central Army Commander’s Commendation Card for these operations in 1995.

More on Dr Pradhan here



Urology is the branch of medicine that focuses on the surgical and medical diseases of the male and female urinary tract system and the male reproductive organs.

The organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis).

Whilst we may not like to think of these parts or functions of our body too much, when you have a malfunction in any of these parts of your body, it is all that you can think about.

The Urinary and reproductive systems are, like all of your other systems, indispensable, fragile in performance, vulnerable to all kinds of conditions and diseases, and seriously debilitating when something goes wrong.

If you have any indications of any problems in these areas, it is recommended that you see a Urologist.

The urinary and reproductive tracts are closely linked, and disorders of one often affect the other. Thus a major spectrum of the conditions managed in urology exists under the domain of genitourinary disorders.

Urology combines the management of medical (i.e., non-surgical) conditions such as urinary tract infections and benign prostatic hyperplasia, with the management of surgical conditions such as bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

You should see a urologist when:

•You are having any difficulties conceiving a child

•You have any problems regarding sexual performance

•You experience erectile dysfunction (ED.)

•You or any relatives have had issues with the prostate gland.

•You experience discomfort in the penis

•You suffer loss of urinary control or Incontinence

•You see blood in your urine

Early detection saves lives and may save you tremendous physical pain and financial cost. The sooner you see a specialist, the sooner you can experience positive change to your health and performance.


The kidneys are a pair of organs located in the back of the abdomen. Each kidney is about 4 or 5 inches long -- about the size of a fist.

The kidneys' function are to filter the blood. All the blood in our bodies passes through the kidneys several times a day.

The kidneys remove wastes, control the body's fluid balance, and regulate the balance of electrolytes.

As the kidneys filter blood, they create urine, which collects in the kidneys' pelvis -- funnel-shaped structures that drain down tubes called ureters to the bladder.

Each kidney contains around a million units called nephrons, each of which is a microscopic filter for blood. It's possible to lose as much as 90% of kidney function without experiencing any symptoms or problems.

A Kidney Biopsy or a Renal biopsy is performed on selected patients with kidney disease. It is most commonly used when less invasive tests are insufficient. The decision on whether or not to proceed to a renal biopsy is usually made by a nephrologist.

The following are examples of the most common reasons for native kidney biopsy:

Haematuria (or blood in the urine) can occur with a number of conditions that affect the kidneys and urinary tract. While renal biopsy is not indicated in all cases of haematuria, it may be performed in those with glomerular haematuria (blood that is thought to come from damage to the glomerulus) or when combined with features of progressive renal disease (e.g. increasing proteinuria, elevated blood pressure and kidney failure). One example is the nephritic syndrome.

Proteinuria (or protein in the urine) occurs in many renal conditions. Renal biopsy is usually reserved for patients with high or increasing levels of proteinuria, or for patients who have proteinuria along with other signs of renal dysfunction. One example is the nephrotic syndrome.

Renal failure (or impaired kidney function due to kidney injury) can occur abruptly (acute renal failure) or progress over a period of time (chronic renal failure). The cause of acute renal failure can usually be determined without renal biopsy. Biopsy is performed in those instances where the cause is uncertain.

Targeted renal biopsy can be used to obtain tissue from a tumour arising from or adjacent the kidney.


The Prostate is an organ forming part of the male reproductive system. It is located immediately below the bladder and just in front of the bowel. Its main function is to produce fluid which protects and enriches sperm. In younger men the prostate is about the size of a walnut. It is doughnut shaped as it surrounds the beginning of the urethra, the tube that conveys urine from the bladder to the penis. The nerves that control erections surround the prostate.

There are four main disorders of the prostate. All can have similar symptoms, which may include one or more of the following:

•Waking frequently at night to urinate

•Sudden or urgent need to urinate

•Difficulty in starting to urinate

•Slow flow of urine and difficulty in stopping

•Discomfort when urinating

•Painful ejaculation

•Blood in the urine or semen

•Decrease in libido (sex urge)

•Reduced ability to get an erection

Most men tend to accept the onset of one or more of these symptoms as being a natural consequence of ageing. However, anyone experiencing any of the above symptoms is advised to consult a doctor without delay. Early expert diagnosis and treatment is important and may avert potentially serious health consequences.

A urologist may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam (DRE), suggest you may have prostate cancer.

Following a prostate biopsy, tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it's likely to grow and spread and to determine your best treatment options.


Removing the prostate gland is called a radical prostatectomy. It is a common operation for treating prostate cancer.

This means using surgery to remove the whole prostate gland. The surgeon does this through a cut in your abdomen or the area between the testicles and the back passage (perineum). The aim of this type of surgery is to cure the cancer.

Your surgeon may suggest radical prostatectomy if:

Your cancer has not spread outside your prostate

You are younger, rather than older, and have a high grade tumour


Hypospadias (hi-poe-SPAY-dee-us) is a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip.

The urethra is the tube through which urine drains from your bladder and exits your body.

In hypospadias, the opening of the urethra is located on the underside of the penis instead of at the tip.

The severity of the condition varies. In most cases, the opening of the urethra is near the head of the penis. Less often, the opening is at midshaft or at the base of the penis. Rarely, the opening is in or beneath the scrotum.

Signs and symptoms of hypospadias may include:

•Opening of the urethra at a location other than the tip of the penis

•Downward curve of the penis (chordee)

•Hooded appearance of the penis because only the top half of the penis is covered by foreskin

•Abnormal spraying during urination

You may feel distressed if your son is born with hypospadias. However, hypospadias is common and doesn't cause difficulty in caring for your infant.

In fact, surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias, most males can eventually have normal adult sexual function.


A hydrocele is a painless buildup of watery fluid around one or both testicles that causes the scrotum or groin area to swell. This swelling may be unsightly and uncomfortable, but it usually is not painful and generally is not dangerous. Although hydroceles are common in newborns, they can also occur at any age in later life.

When a baby boy is developing, inside the mother, the testicles develop near kidneys in the abdomen and descend from that location to their normal position in the scrotum towards the end of pregnancy.

In order for the testicles to leave the abdomen, a muscle ring in the groin on each side opens and allows the testicles to drop down to the scrotum. As the testicle descends, the lining of the abdomen also drops to line the scrotum.

This channel closes in most boys. If that channel remains open, or reopens, a small amount of fluid can go from the abdomen to the scrotum through this passage. This results in hydrocele.

If the channel remains opens or reopens widely, then a portion of the intestine can pass down the channel towards the scrotum. This results in an inguinal hernia.

Hydroceles can also develop due to inflammation or injury within the scrotum. These sometimes resolve over a few months but many remain and require medical attention.

Hernias can also be the result of increased pressure that forces part of the intestines through a weak spot in the abdominal wall — straining during bowel movements, heavy lifting, coughing, sneezing or obesity.

Only about 25 percent of hernias cause pain or discomfort. However, you may be able to see and feel the bulge that often occurs at the junction of the thigh and groin. About 1 percent of boys develop hernias with premature infant males having a higher incidence. Sometimes, the protruding intestine enters the scrotum and causes pain and/or swelling in the scrotum.

About 10 percent of male infants have a hydrocele at birth. Seldom causing symptoms, this swelling of the scrotum does not bother a baby and usually disappears in the first year of life, even though the appearance may worry new parents. In older males, a hydrocele usually remains painless but may cause discomfort due to the increased size of the scrotum.

Surgery to repair the muscle ring that did not close properly is recommended for a hernia in a child. Hernias do not go away on their own and may cause problems with digestion leading to emergency surgery.

In infants and children, a small incision is made in the groin through which a urologist sutures or sews the channel shut and repairs the muscle ring. This procedure can be done in an outpatient setting. In teenagers and adults, laparoscopic surgery may be considered.

Girls do not develop hydroceles. They can develop hernias but because of their anatomy, girls are 10 times less likely than boys to develop hernias.


Kidney stones are made of salts and minerals in the urine that stick together to form small "pebbles." They can be as small as grains of sand or as large as golf balls.

They may stay in your kidneys or travel out of your body through the urinary tract.

The urinary tract is the system that makes urine and carries it out of your body. It is made up of the kidneys, the tubes that connect the kidneys to the bladder (the ureters), the bladder, and the tube that leads from the bladder out of the body (the urethra).

When a stone travels through a ureter it usually causes pain and other symptoms.

Kidney stones form when a change occurs in the normal balance of water, salts, minerals, and other things found in urine.

The most common cause of kidney stones is not drinking enough water.

Try to drink enough water, enough so that your urine is light yellow or clear like water (about 8 to 10 glasses a day). Some people are more likely to get kidney stones because of a medical condition, such as gout.

Kidney stones may also be an inherited disease. If other people in your family have had kidney stones, you may have them too.

Kidney stones often cause no pain while they are in the kidneys. But they can cause sudden, severe pain as they travel from the kidneys to the bladder.

If you think that you have kidney stones, watch for severe pain in your side, belly, or groin or for urine that looks pink or red. You may also feel sick to your stomach (nausea) and may vomit.

You may first find out that you have kidney stones when you see your doctor or go to an emergency room with pain in your belly or side. Your doctor will ask you questions about your pain and lifestyle. He or she will examine you and may do imaging tests such as a CT scan or an ultrasound to look at your kidneys and urinary tract.

You may need more tests if you have more than one stone or have a family history of stones. To find out the cause of your kidney stones, your doctor may order a blood test and ask you to collect your urine for 24 hours. This can help your doctor find out if you are likely to have more stones in the future.

Kidney stones may not cause any pain. If this is the case, you may learn you have them when your doctor finds them during a test for another disease.


The testicles produce male sex hormones and sperm for reproduction. It is the most common type of cancer in young men between the ages of 20-39 years.

Compared with other types of cancer, testicular cancer is quite rare, and it is also the most treatable. If you find testicular cancer early, successful treatment is quite likely.

Not all lumps on the testicles are necessarily tumours, and not all tumours are cancerous either. There are a number of conditions that cause lumps and pain, that are not cancerous.

Symptoms of testicular cancer most commonly include:

> a lump in one testis which may or may not be painful

> sharp pain or a dull ache in the lower abdomen or scrotum

> a feeling often described as "heaviness" in the scrotum

>breast enlargement (gynecomastia) from hormonal effects of β-hcg

>low back pain may occur as the tumor spreads to the lymph nodes along the back

Most often, testicular cancer can be detected at an early stage, and men often find the cancer themselves while performing self-examinations.

Some doctors recommend that men ages 15 to 55 perform a monthly self-examination to identify any changes. However, some testicular cancers may not cause symptoms and may go undetected until they have spread to other parts of the body. Men who notice a lump, hardness, enlargement, pain, or any other change in one or both of their testicles should visit their doctor immediately.

If you are concerned about one or more of the symptoms or signs on the list above, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem.


The urethra is an important part of the urinary tract. While it’s primary job in both genders is to pass urine outside the body, this channel also has an important role in ejaculating semen from the reproductive tract of men. Most people will not have any problems with the urethra, but a few of us may experience the discomfort and dysfunction associated with urethral stricture disease.

What happens under normal conditions?

During urination, the bladder empties through the urethra and out of the body. Urine passes through an opening called the bladder neck into a portion of the urethra surrounded by the prostate, called the prostatic urethra.

The next segment of the urethra is called the membranous urethra and it contains a muscle called the external urinary sphincter. This sphincter allows a patient to voluntarily hold urine and to stop during urination. Together, the prostatic urethra and the membranous urethra make up the posterior urethra, and are approximately one to two inches long.

The urine then enters the bulbar urethra, followed by the penile urethra.

The penile urethra is the segment that runs along the bottom surface of the penis. The exit at the tip of the penis is called the meatus. The bulbar urethra, penile urethra and meatus make up the anterior urethra, which is nine to 10 inches long.

What is a urethral stricture?

A urethral stricture is a scar in or around the urethra, which can block the flow of urine, and is a result of inflammation, injury or infection.

Who is at risk for urethral strictures?

Urethral strictures are more common in men because their urethras are longer than those in women. Thus men's urethras are more susceptible to disease or injury. A person is rarely born with urethral strictures and women rarely develop urethral strictures.

What are some causes of urethral stricture?

Stricture disease may occur anywhere from the bladder to the tip of the penis. The common causes of stricture are trauma to the urethra and infections such as sexually transmitted disease or damage from instrumentation. However, in most cases, no cause can be identified.

In adults, urethral strictures may occur after prostate surgery, removal of kidney stones, urinary catheterization or other instrumentation.

In children, urethral strictures most often follow reconstructive surgery for congenital abnormalities of the penis and urethra, cystoscopy and urethral catheter drainage.

What are the symptoms of urethral strictures?

Some symptoms that may be an indication of urethral strictures can include:

•painful urination

•slow urine stream

•decreased urine output

•spraying of the urine stream

•blood in the urine

•abdominal pain

•urethral discharge

•urinary tract infections in men



Doctors photo
More on Dr Iyer here Dr Subramania K Iyer is Head of the Plastic and Reconstructive Surgery department of the Amrita Institute of Medical Sciences in India. Previous to this he was working in a similar capacity for over 6 years at the Amala Cancer Centre in Trichur, India. Dr. Iyer was a UICC fellow in the Centre Oscar Lambrette in Lille, France and a Craniofacial fellow with Prof. Ortiz Monasterio in Mexico City.

Dr Iyer has vast experience in plastic surgery of a variety of kinds from cosmetic procedures such as Liposuction, breast reduction, tattoo removal or reconstructive procedures like wound repair, facial reconstruction, tumour removal and reconstruction, reconstruction of hand trauma injuries, removals and reconstruction of head and neck cancers and more.

(article from Daily News)
Plastic reconstructive surgery is a discipline that renders enormous beneficial service to many people , but is often misunderstood and underutilised.

Misconceptions include the misunderstanding that procedures are only cosmetic and unwarranted and the majority of people think that it is too expensive. There is also a feeling that it can only be done in very high-tech, modern and sophisticated centres.

A recent visit to SANITAS Hospital in Mikocheni in Dar es Salaam bought us across Dr Subramania Iyer, a visiting surgeon and professor of Plastic and Reconstructive surgery at Amritha Hospoital in Cochin, India.

According to Dr Iyer, teh spectrum of activity a plastic surgeon can offer is vast. He says taht they handle problems from head to toe and give solutions to varied issues related to congenital deformities, accidental deformities, like burns and car crash injuries, cancer surgeries and many fucntional debilitting problems.

Even the management of obese and diabetic peopel can greatly be helped by plastic surgery procedures, he said. The type of patients and results shown by Dr Iyer both in India and here at SANITAS was enough to dispel the myth from my mind that plastic surger was merely for the cosmetic and just for 'appearances'.

Plastic surgery also has a significant role to play in many cases for functionality and making the daily life of a patient easier. 'For example, patients with large breasts often do have problems other than appearance, as many suffer from severe back aches and are incapacitated' he says.

Dr Iyer performed several surgeries where size was reduced whilst retaining excellent shape of breasts, leaving many delighted patients. He says, the problem of large breasts also sometimes occurs in men, particularly relating to diet.

Anoter example of using plastic surgery in aiding the function of the body was in a case where a deformity of the nose led to severe nasal blocks. While correction of nasal blocks needs surgery, clever methods are available to enhance the body image as well.

Children with cleft lip and palate need expert surgical correction to lead to a healthy life as an adult. The ideal time to get this surgery done is in the early stages of life but Dr Iyer said that cases can be corrected at any age as well.

Diabetes is an ever increasing health risk, especially now in Africa and people with the disease can sometimes loose all sensation in their feet and get injuries that could potentially lead to the amputation of one or both feet. One such case was saved from having to be amputated this week at the hospital by Dr Iyer.

Find out more below of these and other conditions that Dr Iyer can help you with. Call SANITAS to make an appointment with Dr Iyer, or email to specialistbooking@sanitasmedics.com



The enlargement of breast tissue in males is known as Gynaemastia. It may occur at any time and there are a number of causes, some physiological and others pathological. Pathological causes involve an imbalance between the activity of androgens and oestrogens. •Gynaecomastia is common and is thought to be present in more than 30% of men, with much higher rates in men over the age of 70 years.

Gynaecomastia can be caused by an imbalance between the sex hormones testosterone and oestrogen. Oestrogen causes breast tissue to grow. While all men produce some oestrogen, they usually have much higher levels of testosterone, which stops the oestrogen from causing breast tissue to grow.

If the balance of hormones in his body changes, this can cause a man’s breasts to grow. Sometimes, the cause of this imbalance is unknown.

The growth in breast tissue is not due to extra body fat from being overweight, so losing weight or doing more exercise will not improve the condition.

There are two types of treatment for gynaecomastia:

•surgery to remove the excess breast tissue
•medication to adjust a hormone imbalance



Large breasts on a small frame or a disproportionate breast weight can cause considerable pain in either the neck region and also on the back, this can have a detrimental affect on overall health and many women may have this surgery for this reason.

Many women request breast reduction surgery for asthetic purposes to 'fix' something they feel is wrong with their body. If a woman feels that her breasts are disproportionate or she is not happy with her general appearance, this surgery can be a big boost for self confidence and general happiness for women. It is important to be completely open with your surgeon and discuss all of the reasons that you wish to have this surgery.

To undergo breast reduction surgery your health must be good and stable. The operation itself can be 2-5 hours long and you will probably require one night in hospital. You should be prepared for some recovery time after your surgery.



Facial clefts of the palate and lips are birth defects in which there is an opening in the lip and/or palate (roof of the mouth) that is caused by incomplete development during early fetal formation.

A cleft occurs when parts of the lip or palate do not completely fuse together during the first 3 months of pregnancy. A cleft lip may appear as a small notch in the edge of the lip only or extend into the nose. It may also extend into the gums.

A cleft palate may also vary in size, from a defect of the soft palate only to a complete cleft that extends through the hard palate. Because the lips and the palate develop separately, it is possible for a child to be born with a cleft lip only, cleft palate only, or both.

The good news is that both cleft lip and cleft palate are treatable. Most kids born with these can have surgery to repair these defects within the first 12-18 months of life. The surgery is simple and a this age recovery is very fast.



If you have suffered injury or deformity to the hands that inhibits proper function and has an affect on your appearance, there are ways to correct these conditions that can give you an improved aesthetic and better functionality.

Hand reconstruction is often necessary to improve mobility and aesthetics in hands that have been affected by a number of different conditions or incidents. These include: Traumatic crush injuries Limb or finger detachment Blood vessel damage Nerve damage Congenital deformity Rheumatoid Arthritis Carpal Tunnel Syndrome Procedures to repair and treat these issues may include medication for less severe cases such as Carpal Tunnel Syndrome, or more invasive surgery such as nerve and tendon repair, microsurgical replantation (reattachment) of detached limbs, and resetting of fractured bones. Several procedures are typically necessary for hand reconstruction surgery. Surgery to correct injury to the hand is usually coupled with skin, muscle, and other tissue replacement or reconstruction in order to restore some feeling and movement to the hands. Techniques involved in tissue, skin, and muscle reconstruction include: Grafting, transfer of bone, skin, tissue, or nerves from a healthy area of the body to treatment site Flap Surgery, movement of fat, blood vessels, muscle, and skin from a healthy donor site on the patient’s body to the injured hand Transplantation / Replantation, reattachment of hands or fingers through a precise microsurgical procedure

There can be many types of cancers of the upper extremity, such as of the skin. This could include basal and squamous cell carcinomas as well as melanomas, and those arising from muscle and bone which, many times, are various forms of sarcomas. Our specialists not only remove these cancers but are capable of returning the area back to normal. Although all of our plastic surgeons have hand training, a number have had additional training focusing on the upper extremities. These specialists not only work closely with specialized oncologists and radiation oncologists, but also hand and physical therapists to ensure our patients received the best chance of functional recovery.



Sometimes after an injury or even a surgery you can be left with a scar that is quite prominent or just affects your confidence because of its location. Dr Iyer specializes in scar revision, that is the process of reassessing the scars and modifying them surgically to reduce their appearance.

There are different surgical techniques used in scar revision that are designed to make the scar as smooth and invisible as possible. This can involve recreating the incision, moving skin around or even moving the scar to make it less visible. What would work best for your specific scar will depend on where it is located and how it looks, your surgeon will evaluate you and discuss the options for revision surgery.

Some scars, especially when raised, may be improved with dermabrasion. These are methods a surgeon uses to make “rough or elevated” scars less prominent, by removing part of the upper layers of skin with an abrading tool. Clearly, the scar will remain, but will be smoother and less visible.

Keloid or hypertropic scars are often treated first with injection of medications to reduce size. If this is not satisfactory, the scars can be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars.



Every year thousands of people choose to have a nose surgery of some kind. In many cases it is asthetic and chosen because the person feels self conscious about the shape or size of their nose. Having this corrected can have an immeasurable affect on a persons self confidence.

In other cases the need for a surgery on the nose can rise from breathing difficulties or correct abnormalities caused by trauma or a birth defect. The procedure can change your nose’s overall size, tip, bridge and nostrils.

The term rhinoplasty is derived from the German “rhinoplastik” which means “changing the shape of the nose”. The technique involves first accessing the bone and cartilage support of the nose. This is achieved through incisions made inside the nose, where they are invisible.
Next, the underlying bone and cartilage is reduced, augmented or rearranged to create a newly shaped structure. For example, if the tip of the nose is too large, the surgeon can sculpt the cartilage in this area to reduce it in size. If the bridge of the nose has a prominence, this can be reduced to yield a more pleasing profile. If any portion of the nose appears disproportionately small, cartilage or soft tissue grafts can be placed to create better harmony. The angles of the nose in relation to the upper lip or the forehead can also be altered by further sculpting the nasal support structure.



Otoplasty or cosmetic ear surgery can improve the shape, position or proportion of the ear. It can correct a defect in the ear structure that is present at birth, such as overly large ears or protruding ears, and can also treat ear shape that becomes more noticeable with development or misshapen ears caused by injury.

This surgery is most commonly requested for children or young people who are particularly self conscious about the size or shape of their ears or how they stick out from their head. This self conscious effect can severely damage the confidence of a child. A very simple surgery can correct this condition and make an enormous difference to the mental wellbeing of a child.

Surgery begins with an incision just behind the ear, in the natural fold where the ear is joined to the head. The surgeon will then remove the necessary amounts of cartilage and skin required to achieve the right effect. In some cases, the surgeon will trim the cartilage, shaping it into a more desirable form and then pin the cartilage back with permanent sutures to secure the cartilage. This surgery is only on the external structure of the ear and will not affect hearing.



Aging of the face is inevitable, over time the skin begins to loosen on the face and neck. Crow’s feet appear at the corners of the eyes. Fine forehead lines become creases and then, gradually, deeper folds. The jawline softens into jowls, and beneath the chin, another chin or vertical folds appear at the front of the neck.

Heredity, personal habits, the pull of gravity, and sun exposure contribute to the aging of the face. Different cultures and races are affected differently by facial aging and place different importance on facial appearance. For some cultures facial aging is seen as a sign of maturity and wisdom and in other cultures the preservation of young facial features is more valued.

Facial surgery may involve just small contouring events, removing fat or tightening skin in particular places or it may be more comprehensive where the skin is pulled from multiple points around the forehead and back of the ears to provide a complete facial 'lift'.These 'lifts' can be conducted on both men and women.

These surgical lifts are conducted at the surface level and usually involve only the skin, some minor rearrangement of fat or tissue beneath the skin. This is different from facial reconstructive surgery which involves the addition of bone implants, or removal of bony growths and probably multiple surgical events to change the shape of the foundation of the face rather than just the external appearance.



What are craniofacial anomalies?
Craniofacial anomalies (CFA) are a diverse group of deformities in the growth of the head and facial bones. Anomaly is a medical term meaning "irregularity" or "different from normal." These abnormalities are congenital (present at birth) and there are numerous variations--some are mild and some are severe and require surgery.

What causes craniofacial anomalies?

Most medical professionals agree that there is no single factor that causes these types of abnormalities. Instead, there are many factors that may contribute to their development, including the following:

• Combination of genes. A child may receive a particular combination of gene(s) from one or both parents, or there may be a change in the genes at the time of conception, which results in a craniofacial anomaly.

• Environmental. The effect of environmental exposures on the development of craniofacial abnormalities is not fully understood. However, environmental exposures may play a role, especially in combination with genetic abnormalities.

• Folic acid deficiency. Folic acid is a B vitamin found in orange juice, fortified breakfast cereals, enriched grain products, and green, leafy vegetables. Studies have shown that women who do not take sufficient folic acid during pregnancy, or have a diet lacking in folic acid, may have a higher risk of having a baby with certain congenital anomalies, including cleft lip and/or cleft palate.

What are the most common types of craniofacial anomalies?

Some of the most common types of craniofacial anomalies include the following:

• Cleft lip and/or cleft palate. A separation that occurs in the lip or the palate (roof of the mouth), or both. Cleft lip and cleft palate are the most common congenital craniofacial anomalies seen at birth.

◦ Cleft lip. An abnormality in which the lip does not completely form. The degree of the cleft lip can vary greatly, from mild (notching of the lip) to severe (large opening from the lip up through the nose).

◦ Cleft palate. Occurs when the roof of the mouth does not completely close, leaving an opening that can extend into the nasal cavity. The cleft may involve either side of the palate. It can extend from the front of the mouth (hard palate) to the throat (soft palate). The cleft may also include the lip.

• Craniosynostosis. A condition in which the sutures (soft spots) in the skull of an infant close too early, causing problems with normal brain and skull growth. Premature closure of the sutures may also cause the pressure inside of the head to increase and the skull or facial bones to change from a normal, symmetrical appearance.

• Hemifacial microsomia. A condition in which the tissues on one side of the face are underdeveloped, affecting primarily the ear (aural), mouth (oral), and jaw (mandibular) areas. Sometimes, both sides of the face can be affected and may involve the skull, as well as the face. Hemifacial microsomia is also known as Goldenhar syndrome, brachial arch syndrome, facio-auriculo-vertebral syndrome, oculo-auriculo-vertebral spectrum, or lateral facial dysplasia.

• Vascular malformation. A birthmark or growth, present at birth, that is composed of blood vessels and can cause functional or aesthetic problems. Vascular malformations may involve multiple body systems. There are several different types of malformations and they are named according to which type of blood vessel is predominantly affected. Vascular malformations are also known as lymphangiomas, arteriovenous malformations, and vascular gigantism.

• Hemangioma. A hemangiomas is an abnormally growing blood vessel in the skin that may be present at birth (faint red mark) or appear in the first months after birth. A hemangioma is also known as a port wine stain, strawberry hemangioma, and salmon patch.

• Deformational (or positional) plagiocephaly. A misshapen (asymmetrical) shape of the head (cranium) from repeated pressure to the same area of the head. Plagiocephaly literally means "oblique head" (from the Greek "plagio" for oblique and "cephale" for head).


Radiation is naturally occurring all through our environment. An x-ray machine takes all of that radiation and brings it together and directs it through the machine in one ray. So a single x-ray is hardly more radiation than you might be exposed to naturally. The X-ray machines fires the radiation like a beam of light for just a fraction of a second, after it is turned off no radiation remains, in your body, or in the air or room around you. So x-ray is considered quite safe.

However for children, unborn babies, elderly or people immune compromised it could have some detrimental effect in large doses, although this is not proven it is best to err on the side of caution. If you are pregnant, have a pacemaker, or are undergoing cancer therapy or have any condition that significantly weakens your immunity you should let the technician know so they can make the safest decision for you.


Like any other exam, there are differences according to the part of the body that the investigation is targeting. A standard X-Ray may be for the Chest, Cranium, Spine, Forearm, Tibia, Ankle, Fingers, Wrist, facial etc. Different X-Rays can be taken in different positions, sometimes standing up, sometimes laying down, sometimes from the side, sometimes from both sides. The doctor will request the position and angle according to what symptoms are being investigated.

Additionally to these standard X-Rays there are different X-ray procedures that include Barium and Angiography, which involve taking an image of the body after swallowing a liquid dye that shows up in the X-ray. This is used to show blood flow and clots etc.


A Chest X-ray is one of the most commonly prescribed X-rays and is often requested when a doctor is investigating:

  • > Chest pain
  • >Persistent fever
  • >suspected pneumonia
  • >Persistent cough
  • >heart failure, heart conditions
  • >and many more medical symptoms.

A chest X-Ray is most often performed whilst you are standing up. The technician will stand you in front of a square panel, they will adjust it as much to your height and comfort as possible, although you may be required to hold a particular posture for a few minutes, which can be slightly uncomfortable. When you are in the correct position, the technician will leave you alone in the X-ray room for a few seconds in order to take the image. The whole process of preparing, positioning you and taking the image and ensuring the correct image is taken may take up to 15 minutes, although can be even much faster.


Ultrasound is a method for medical practitioners to look inside your body, that is non invasive and does not use radiation or any harmful chemicals or uncomfortable postures. For most Ultrasound procedures you will be asked to lay down on an exam bed, and relax. The technician will ask you to uncover your chest, abdominal or pelvic region, depending on the area that is being scanned. The technician will then put some gel onto the area, this may feel cold, but it is water based, will not damage your skin or clothing in any way whatsoever. The transducer/probe (small wand connected to the ultrasound machine) will then be slowly moved around across the gel area, and you will be able to see the images being produced on the machine.

If at any time during a physical exam you are always welcome to bring a friend or family member with you, or request a nurse or other member of staff if you need comfort or distraction during the exam. Most Ultrasound procedures are over within 30 minutes or less.

An Ultrasound machine uses sound waves, which are directed through a probe or transducer connected to the machine, and using sonographic technology these waves send an image back to the machine. An Ultrasound machine can produces images in real time, so it can give information about the movement of body organs and even blood flow through the veins. An ultrasound image can show details of soft tissue and organs that are not visible in an x-ray.


An Ultrasound is a non-invasive procedure, there is no cutting or needles or squeezing of body parts. For most ultrasound exams, you will be positioned lying face-up on an examination table. Sometimes, depending on the exam requested, you may be turned to either side or on occasion placed in a face down position to improve the quality of the images. The technician will put some water-based gel onto your skin in the area that is being scanned. The gel helps create an unbroken channel for the radio waves from your body to the machine, without disruption from air or bubbles. The technician will hold the probe or transducer flat against that area of the body, on the gel, and move it back and forth. It may feel a bit cold, or a bit strange, but that is usually the most discomfort that you will experience. Once the imaging is complete, the gel will be wiped off your skin, it does not leave any mark or stain or discolour clothing. There are different kinds of ultrasounds, in different parts of the body for different investigative purposes, please see below for more information on some of the most common below:


An abdominal ultrasound is a scan around the mid to upper abdominal region, it can be used to see:

  • >Kidneys
  • >Liver
  • >Gallbladder
  • >Pancreas
  • >Spleen
  • >Abdominal arteries

This type of ultrasound may be prescribed by your doctor to investigate or diagnose organ damage after injury, kidney function, abdominal pain, causes of abdominal swelling, looking for causes of fever, looking for stones in the gallbladder or kidneys, or the diagnosis of tumours and cancers.
To prepare for this test you may be asked if you have eaten that day as images can be better when the stomach is not full. It will depend on the urgency and the part of the body that your doctor is investigating. This Ultrasound procedure is usually completed within 30 minutes or may be less. You are always welcome to bring a friend or family member with you, or request a nurse or other member of staff if you need comfort or distraction during the procedure.


A Pelvic Ultrasound is a scan of the organs in your pelvic region, the lower abdominal/belly area. It is most often prescribed for women when investigating:

  • >Pelvic pain
  • >Abnormal bleeding
  • >Menstruation cycles
  • >Bladder conditions
  • >Many types of cysts, tumours and growths
  • >the source of fever
  • >The Uterus and cervix
  • >Swelling in pelvic organs

It may also be prescribed for men when investigating issues of:
  • >Prostate
  • >Seminal vesicles
  • >Bladder

To prepare for this Ultrasound you may be asked to drink a large volume of water, until your bladder is full. It is the same non-invasive non-painful procedure, but because you are required to keep your bladder full during the procedure, it may be a little uncomfortable. This Ultrasound procedure is usually completed within 30 minutes or may be less. You are always welcome to bring a friend or family member with you, or request a nurse or other member of staff if you need comfort or distraction during the procedure.


An Obstetric Ultrasound is ordered by your doctor usually when you are pregnant, to assess many things that the doctor needs to know such as:

  • >Presence of the foetus
  • >Position of the foetus
  • >evaluating the condition of the uterus, placenta, cervix etc
  • >Assessing the age and growth rate of the foetus

This ultrasound is performed as any other, it is non-invasive, not painful at all, just your belly area is exposed and the gel is used to assist the machine to produce the best images. During this exam, you will be able to see your baby on the screen, perhaps see the heart beating and depending on the age of the foetus you may also be able to ask if it is a boy or a girl. This Ultrasound procedure is usually completed within 30 minutes or may be less. You are always welcome to bring a friend or family member with you, or request a nurse or other member of staff if you need comfort or distraction during the procedure.


An Ultrasound of the breast, or both breasts may be requested by your doctor after a physical breast exam, where there is perhaps hardness in the breast or a specific lump found, or an unidentified discharge from the nipple.

A Breast Ultrasound is not the same as a breast x-ray (Mammogram)but it can identify conditions that a breast x-ray cannot, and it is also a useful tool in breast examination when a woman is pregnant and should not be exposed to ionizing radiation which is used during x-ray.

A breast Ultrasound can produce images showing different tissue densities, and blood flow to areas of suspected tissue. It is not the be all and end all in breast cancer diagnosis, but is a very important supplementary examination. If a Mammogram shows suspected breast cancer, a breast Ultrasound can give more information on the suspected tissue, and the Ultrasound can also be used during a biopsy procedure to sample the tissue at the most appropriate spot (Ultrasound guided breast biopsy).

A breast Ultrasound is conducted as for all other ultrasounds, usually you will be laying on your back on the exam bed, your breast/s will be uncovered, the gel will be placed in the area of interest, this may be cold but no other discomfort is there. The technician will move the transducer/probe across and around the breast mass to get full images. As for any other physical exam you are welcome to bring a friend or family member, or request a nurse or other staff member to be present if you need comfort or distraction during the procedure. The full exam will usually take not more than 30 minutes, although if both breasts are being scanned it may run a little over this.


A Transvaginal Ultrasound is only for women, it is a different method of conducting the pelvic or obstetric ultrasound. However, it is a little more like a gynecological exam as the probe rather than being placed on top of the skin in the pelvic/abdominal region, it is placed into the vagina. This places the probe inside the body and much closer to the organs and in the case of pregnancy much closer to the foetus.

This type of Ultrasound is very helpful in cases where the pregnancy is ectopic (where the foetus is developing in the fallopian tubes instead of in the uterus), where the pregnancy is very early for a better image, and also can gain better images where the patient maybe overweight and the standard ultrasound image is obstructed by extra fatty tissue.

For this type of Ultrasound method, rather than filling up your bladder before the exam, you will be asked to empty your bladder before the exam. There is no other special requirement except to be relaxed. You are welcome to bring a friend or family member with you if you need to have someone to talk to or you may request a nurse or other staff member to also be with you if you are at all tense about this exam.

In this type of Ultrasound your privacy and comfort is paramount, if you are at any time uncomfortable you may say so. If you are not comfortable for any reason with the technician you may request a different one. It is not as uncomfortable as say a pap smear procedure, as the probe is narrow and is only inserted 2-3 inches. All protocols of sterilization and preparation are followed for the probe and each different exam a new cover is also placed over the probe along with the normal gel. The images are produced by moving the probe at different angles. The procedure should not take more than 30 minutes from start to finish, most usually less.


A Doppler Ultrasound uses the same machine, same transducer/probe, the method as the above pelvic and abdominal ultrasounds, but it is targeted at different parts of the body, in particular arteries. A Doppler Ultrasound uses the same sound waves that are used to give a picture of your organs or your baby, to give a picture of blood flow through different arteries. It can be used to measure the blood flow in external parts of your body like arms and legs, and also in the foetus if you are pregnant.

A Doppler Ultrasound is an important tool in Monitoring and diagnosis of heart rate and blood flow in the foetus, blood flow to the foetus, blood vessel defects, cardiac malformations, less than normal or absent blood flow to different organs, narrowing of blood vessels and a multitude of blood flow symptoms that can affect your wellbeing.

A Doppler ultrasound produces images in colour that show the strength and direction of flow of the blood within the vessels. A Power Doppler also shows fine details of blood flow, which is particularly important if blood flow is reduced in a particular area.

There are no special requirements for a Doppler Ultrasaound, you only need to relax. It will usually take place laying on your back, sometimes on your side. The same transducer/probe is used and the gel is applied and the technician will move the transducer/probe across your skin in the target area. The full procedure should not take more than 30 minutes, although in cases where more than one limb is being examined it could be up to 45 minutes-1 hour, but very rarely.


ECHOCARDIOGRAM or Echo, is another non-invasive that uses sound waves or radio waves to produce an image of what is happening inside your body. Echo is mainly used to investigate heart conditions or symptoms.

A TransThoracicEchocardiogram (TTE) is the most common type of Echo that is requested by doctors. As with other sonographic investigations it is non-invasive and should not be uncomfortable at all. You will be laying on an exam bed on your back, the doctor or technician may conduct the test. They will put some gel on the chest/abdominal area and the transducer/probe will be moved through the gel across the chest/abdominal area. From start to finish this exam should not take more then 20-30 minutes.

At SANITAS your Echo may be conducted by the technicians in the Medical Imaging unit, or it may be conducted in the physicians consulting room itself.