Gain exposure, and the patient was placed into suspension. A red rubber catheter was used to gently retract the soft palate. The tonsillectomy was performed with a monopolar bovie cautery equipped with a guarded standard tip on the settings of 12 for spray coagulation and 5 for cut. Tonsillar traction was achieved with a straight tonsil grasper, and resection proceeded in a superior to inferior direction. Minor bleeding after the resection was controlled with the monopolar suction bovie cautery on the settings of 12 for spray coagulation and 0 for cut. The adenoidectomy was performed with an adenoid curette followed by use of the suction bovie cautery on the settings of 30 for spray coagulation and 0 for cut. The adenoidectomy was uneventful, but during the tonsillectomy, the patient's right superior constrictor muscle dehisced near the center of the tonsillar fossa, resulting in fat herniation. Primary closure of the defect was attempted, but the thinned scom did not allow for an adequate closure. Therefore, a superiorly based palatoglossal flap was fashioned with a # 15 blade and rotated to cover the defect. The flap design provided enough width to capture the thicker lateral portions of the scom and incorporate them into the closure (figure). The flap was secured in place with 4-0 vicryl sutures in an interrupted fashion. Often, primary repair of the defect in patients with a history of chronic tonsillitis is not possible because of the thin and weak nature of the scom. We propose the following grading system for scom defects during tonsillectomy: * type i: a minor amount of fat herniation is present; the surgeon can leave the defect unaddressed. * type ii: a small amount of fat herniation is present; the surgeon can close the scom primarily. * type iii: a significant amount of fat herniation is present; the surgeon cannot close the scom primarily. * type iv: a type iii defect plus carotid exposure/ injury and/or subcutaneous emphysema are present. For type iii and iv defects, we advocate the use of a palatoglossal flap, which is based on branches of the ascending palatine artery. (1) the flap may be either superiorly or inferiorly based, and it should be wide enough to capture the thicker lateral segments of the scom within the fossa. viagra online viagra online buy generic viagra viagra without a doctor prescription viagra without a doctor prescription cheap generic viagra cheapest price on viagra cheap viagra online cheap generic viagra cheap viagra online We recommend fashioning the flap in place with the use of an absorbable suture that provides adequate strength (e. G. , vicryl). The postoperative care of a patient with a type iii or iv defect should include chest x-ray, adequate analgesia, a 1-week course of antibiotics that cover oral flora, and a minimum of 23 hours of observation. The physical examination should include (1) palpation of the neck and chest for subcutaneous emphysema, (2) oropharyngeal examination to assess flap integrity, bleeding, or clot, and (3) auscultation of the chest. A finding of subcutaneous air, gross oropharyngeal hemorrhage, persistent fever, or shortness of brea.

Katy Woollatt is a glass designer and maker from Leeds, UK.

After studying at Manchester Metropolitan University and specialising in glass blowing and jewellery making, Katy furthered her glass making skills at the International Glass Centre in Brierley Hill, West Midlands. She went on to work for a short time at the World of Glass Museum in St Helens, demonstrating glass making methods to the public, developed her own ranges of work for sale, and has taken part in a variety of exhibitions in the UK.

Since then, Katy has found inspiration by travelling and living abroad, and has worked with glass artists and also taught classes in glass and jewellery making in different countries.

Katy no longer makes glass blown pieces but hopes to continue her journey in glass in the future.

“My designs are heavily influenced by studies of the ocean and it’s creatures. Glass is the perfect medium for this, as the swirling blue you can see in my designs almost create themselves in the making process, as when the glass is in a molten the layers of colour twist around themselves as the glass is turned on the iron. I researched how man-made objects become encrusted in the ocean and studied folklore and stories about being lost at sea, and tried to recreate them as a piece of art”.