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CHAPTER 17

CHAPTER 17. Otorhinolaryngologic Surgery. Objectives. After studying this chapter, you will be able to: Recognize the relevant anatomy of the ear, nose, and upper aerodigestive tract Summarize the pathology that prompts otorhinolaryngologic surgical intervention and the related terminology

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CHAPTER 17

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  1. CHAPTER 17 Otorhinolaryngologic Surgery

  2. Objectives • After studying this chapter, you will be able to: • Recognize the relevant anatomy of the ear, nose, and upper aerodigestive tract • Summarize the pathology that prompts otorhinolaryngologic surgical intervention and the related terminology • Determine any preoperative otorhinolaryngologic diagnostic procedures/tests

  3. Objectives (cont’d.) • Determine any otorhinolaryngologic preoperative and intraoperative preparation procedures • Indicate the names and uses of otorhinolaryngologic instruments, supplies, and drugs • Indicate the names and uses of special otorhinolaryngologic equipment • Summarize the surgical steps of the otorhinolaryngologic procedures

  4. Objectives (cont’d.) • Interpret the purpose and expected outcomes of the otorhinolaryngologic procedures • Recognize the immediate postoperative care and possible complications of the otorhinolaryngologic procedures • Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the otorhinolaryngologic patient

  5. Introduction to Otorhinolaryngologic Surgery • Otorhinolaryngologic surgery • Ranges • Simple procedures: myringotomy • Complex procedures: laryngectomy • Involves treating diseases and trauma • Includes plastic surgery procedures that often include microsurgery on very small structures

  6. Ear Procedures • Many surgical options are available • Correct deformities of the ear • Restore function of the ear

  7. Diagnostic Procedures/Tests for the Ear • Tuning fork • Small two-pronged metal device • Emits a clear tone of a fixed pitch when tapped • Used as a diagnostic tool to perform an initial assessment of a patient’s level of hearing • May be used intraoperatively on a patient under local anesthesia to determine improvement

  8. Diagnostic Procedures/Tests for the Ear (cont’d.) • Audiometry • More sophisticated method of testing a patient’s hearing • Audiometer • Machine capable of emitting a tone at several different pitches and volumes • Patient indicates to the examiner which sounds are heard

  9. Diagnostic Procedures/Tests for the Ear (cont’d.) • Otoscope • Handheld, lighted instrument for viewing the external auditory canal • Refer to Figure 17-1 • Computed tomography (CT) scan (i.e., computed axial tomography scan) and magnetic resonance imaging (MRI) • Specialized noninvasive methods of viewing the inside of the body

  10. Diagnostic Procedures/Tests for the Ear (cont’d.) • Tympanogram • Measures vibrations of the eardrum by placing a probe against the tympanic membrane • Electronystagmography (ENG) • Tests the balance mechanism in the inner ear • Cool, then warm liquid is introduced into the ear canal • Stimulates rapid eye movements

  11. Routine Instruments, Equipment, and Supplies • Basic ear procedure instrument tray • Refer to Figure 17-2 • Routine supplies • Refer to text

  12. Practical Considerations • Operating room and equipment • Prepared prior to the arrival of the patient • Microscope • Preparatory steps must be followed for use • Ear surgery preparation • Operating table is reversed • Refer to Figure 17-3 • Patient position: supine

  13. Practical Considerations (cont’d.) • Anesthesia • Usually general anesthesia supplemented with a local anesthetic with epinephrine • Draping • May be extensive: head wrap, towels, ear drape, etc. • Dressing • May be a very simple (e.g., cotton ball) or quite complex (e.g., mastoid)

  14. Practical Considerations (cont’d.) • Repair or replacement of damaged or diseased ossicles or the tympanic membrane • Several options • Autografts (from the same person) • Allografts (from the same species) • Xenografts (from animals) • Synthetic grafts

  15. Procedures • Include: • Myringotomy    • Tympanoplasty • Mastoidectomy • Stapedectomy • Cochlear implant

  16. Nasal Procedures • Nose • Facial feature • Serves at the organ for the sense of smell and as the upper portion of the respiratory system • Nose and paranasal sinuses • Prone to suffer several types of pathological conditions

  17. Nasal Diagnostic Procedures/Tests • Diagnostic approaches to nasal and paranasal sinus pathology • Direct vision • Mirror examination • Radiograph

  18. Routine Instruments, Equipment, and Supplies • Instrumentation for rhinoplasty • Differs from the instrumentation for internal nasal and sinus surgery • Endoscopic sinus surgery • Requires specialized instrumentation and auxiliary equipment • Sample nasal instrument set • Refer to Table 17-1

  19. Routine Instruments, Equipment, and Supplies (cont’d.) • Routine equipment • Headlamp • Electrosurgery unit (ESU)  • Power drill • Insulated ESU with suction attachment • Bipolar unit  

  20. Routine Instruments, Equipment, and Supplies (cont’d.) • Routine supplies • Basic back table pack • Bar drape and U-drape • Prep and basin set • Gloves • No. 10 and No. 15 knife blades • ESU pencil • Bipolar forceps • Suction system

  21. Practical Considerations • Patient positioning • Supine position with the head placed in a donut or foam headrest, or a roll placed under the scapular region • Planned local anesthetic • Anesthesia provider will not be in attendance • Use of a small table (prep stand) or second Mayo stand may be requested to hold the supplies for administration

  22. Practical Considerations (cont’d.) • Eyewear • Provisions to protect and prevent drying of the patient’s eyes should be made • Facial hair • Removal is usually not necessary • Draping • May include a turban-style wrap, wound towels, bar sheet, and split sheet or U-drape

  23. Practical Considerations (cont’d.) • Following nasal procedures • Nose may be packed with gauze, which may be dry or impregnated with ointment • Nose and sinus surgery • Generally done on an outpatient basis • Procedures performed through the nose • Not considered sterile procedures

  24. Submucous Resection (SMR) • Mucous membrane lining the nasal cavity will be incised • Underlying perichondrium or periosteum lifted • Structures underlying the mucous membrane will be removed to help restore normal breathing • Mucous membrane is then laid back into position and held there with nasal packing material

  25. SMR/Septoplasty • Purposes • Straighten a deviated nasal septum • Repair a perforated septum or one damaged by trauma • Submucosal approach is used • Cartilaginous or osseous portion of the septum causing nasal obstruction is removed, readjusted, or reinserted

  26. Procedures • Include: • SMR/septoplasty • Turbinectomy • Polypectomy • Choanal atresia repair • Functional endoscopic sinus surgery (FESS) • Intranasal antrostomy • Caldwell-Luc

  27. Oral Cavity and Throat Procedures • Oral cavity and throat • Consist of several individual and specialized structures that work in harmony to facilitate respiration and ingestion of food • Pharynx, larynx, trachea, and esophagus • Can be affected by several conditions • Range from minor inflammatory to malignancy as well as mechanical disorders

  28. Diagnostic Procedures/Tests for the Oral Cavity and Throat • Include: • Direct and indirect visualization • Laboratory tests • Culture and sensitivity • Blood count • Radiologic examinations • X-rays • CT scans • MRI

  29. Diagnostic Procedures/Tests for the Oral Cavity and Throat (cont’d.) • Videostroboscopy • Polysomnography • Multiple Sleep Latency Test (MSLT)

  30. Routine Instruments, Equipment, and Supplies • Instrumentation used for oral cavity and throat procedures • General surgery major instrument tray with add-ons such as skin hook retractors • Exceptions are tonsillectomy and adenoidectomy, and tracheostomy instrument trays: refer to Tables 17-2 and 17-3 • Some health care facilities may have a specialty neck instrument tray

  31. Routine Instruments, Equipment, and Supplies (cont’d.) • Operating microscope • Critical part of laryngeal surgery • Refer to Figure 17-26 • Laser surgery • Becoming common in procedures involving the larynx and oropharynx

  32. Routine Instruments, Equipment, and Supplies (cont’d.) • Additional important components • Illumination devices and sitting stools • # No. 12 knife blade • Endoscopes, laryngoscopes, bronchoscopes, and esophagoscopes • Video equipment • Insulated electrosurgical devices • Histological stains and topical anesthetics • Lukens tubes

  33. Practical Considerations • Patient positioning • Depends on the patient’s age, type of surgery, and type of anesthetic • Majority will be supine • General anesthesia • Usually the anesthesia of choice • May be supplemented with a local or topical anesthetic

  34. Practical Considerations (cont’d.) • Supplies • Medicine cups, syringes, and needles • Cotton tip applicators • Anesthetic of choice • Atomizer • Tongue blades • Laryngeal mirror • Small basin of warm water • Gauze sponges

  35. Procedures • Include: • Tonsillectomy and adenoidectomy • Parotidectomy • Uvulopalatopharyngoplasty (UPPP) • Laryngectomy • Radical neck dissection with mandibulectomy • Temporomandibular joint arthroscopy • Tracheotomy

  36. Summary • This chapter reviewed: • Anatomy of the ear, nose, and upper aerodigestive tract • The pathology that prompts otorhinolaryngologic surgical intervention • Otorhinolaryngologic diagnostic procedures/tests • Otorhinolaryngologic instruments and supplies • Otorhinolaryngologic procedures

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