ENT PROCEDURES 10 Tympanomastoidectomy

Tympanomastoidectomy

Objective

In cases of loss of hearing due to chronic suppurative ottitis media with unsafe atticoantral type disease.

Position

Supine with head turned diseased side up.

Anesthesia

Local.

Procedure

   1.  Post aural/and aural incision.

   2.  Harvesting the temporalis fascia graft.

   3.  Elevation of posterior meatal wall skin flap.

   4.  “Outside in”/or “Inside out” approach to be used for bone work.

   5.  Exploration of mastoid antrum.

   6.  Exposure of tegmen tympani, sinus plate, tip cells and lateral semicircular canal.

   7.  Removing the posterior meatal wall and defining the fascial ridge.

   8.  Clearance of disease from peripheral labyrinthine cells and removal of outer attic and wall bridge.

   9.  Clearance of disease from middle ear.

10.  Wide meatoplasty.

11.  Reconstruction of ossicular chain, and placement of graft.

12.  Gelfoam/ear packing.

13.  Closure of skin wound.

Instruments

•   Stapes set 1

•   Skin knife

•   Iris scissors

•   Fine forceps

•   Cautery mastoid drill

•   Mastoid retractor

•   Gauges

•   Chisel

•   Bone curettes

•   Suction.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com
Also available now on android & smartphones same address

ENT PROCEDURES 9 Myringplasty

Myringoplasty

Objective

In cases of loss of hearing due to Chronic suppurative otitis media with safe central perforation in the tympanic membrane.

•   To repair the defect

•   To restore hearing.

Position

Supine with head turned to one side with the ear to be operated uppermost.

Anesthesia

Local same as described for stapes surgery.

Procedure

1.  Harvesting the graft-temporalis fascia and tragal perichond­rium. Overlay technique.

2.  Complete de-epithelialization of deep meatal skin and that of tympanic membrane remnant.

3.  Placement of graft over the defect and on to the meatal wall.

4.  Placement of gelfoam/ear dressing.

Under lay technique

1.  Elevation of tympanomeatal flap.

2.  Placement of silastic sheeting/gelfoam in the middle ear.

3.  Placement of graft and replacing the tympanomeatal flap.

4.  Gelfoam/ear dressing on the ear canal.

Instruments

Myringotomy set.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

ENT PROCEDURE 8 stapedectomy

OTOLOGY

Stapedectomy

Objective

•   In cases of loss of hearing due to otosclerosis.

•   To restore hearing by removing the stapes.

Position

Supine with patient’s head turned to the side with the ear to be operated uppermost.

Anesthesia

Local (Premedication given 45 min before surgery).

Procedure

   1.  Preparation of the part.

   2.  Placement of correct size ear speculum.

   3.  Use of operating microscope.

   4.  Injection of local anesthesia.

   5.  Incision in deep meatus at 6-12 o’ clock position in posterior wall 6 mm from tympanic annulus.

   6.  Elevation of tympanomeatal flap including the annulus.

   7.  Bony overhang in posterosuperior part to be curretted to expose the stapes area.

   8.  Making a hole in stapes footplate.

   9.  Division of stapedius tendon.

10.  Disarticulation of incus-stapedial joint.

11.  Enlarging the hole in the footplate.

12.  Measuring the distance between footplate and long process of incus.

13.  Placement of Teflon piston over long process of incus.

14.  Replacement of tympanomeatal flap.

15.  Placement of gel foam/and ear dressing in external canal.

Instruments

Stapes set

•   Circular knife

•   Microscissors

•   Zollner elevators

•   Bone curettes

•   Right angle needles

•   Straight needle stapes microdrill

•   Crocodile ear specula of different sizes

•   Speculum holder measuring rod and grid

•   Suction tube and suction tips.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

ENT PROCEDURE 7 TRACHEOSTOMY

Tracheostomy

Objective

The establishment of an opening into the trachea below the larynx for the insertion of a tube for the purpose of providing an airway in cases of upper respiratory obstruction.

Position

Supine, with a sand bag under the shoulder, blades, neck extended, with the head thrown well back and the chin in the midline.

Anesthesia

•   In cases of emergency, local field block or no anesthesia

•   In elective cases, general anesthesia.

Procedure

   1.  The trachea is fixed between the thumb and middle finger in the midline and an incision is given dividing the skin and platysma.

   2.  In cases of urgency a vertical incision, running from just an inch above the cricoid cartilage to the suprasternal notch.

   3.  In elective cases a transverse incision is given along the skin creases, midway between the cricoid cartilage and the suprasternal notch.

   4.  The strap muscles are retracted laterally to expose the trachea with the overlying isthmus of thyroid.

   5.  The isthmus is freed by dividing the pretracheal fascia in front of cricoid cartilage.

   6.  The freed isthmus can be divided pulled down with the blunt tracheal hook to expose the tracheal rings.

   7.  Now inject a few drops of topical anesthetic into the trachea to minimize the bout of coughing on sudden opening of the trachea.

   8.  The trachea is fixed by means of a sharp hook and second and third tracheal rings are divided in midline.

   9.  The opening so formed is dilated using tracheal dilator.

10.  A correct size tube is selected and introduced into the opening.

Instruments

Tracheostomy set.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

ENT PROCEDURE 6 ( TONSILECTOMY

Tonsillectomy and Adenoidectomy

Objective

•   Enucleation of the tonsils either by dissection or guillotine so as to remove an infected gland

•   And curetting of the adenoids. 

Position

•   Dissection: Supine, with the head and neck in extension 

•   Guillotine: First supine with the head to one side, and then lateral for adenoidectomy.

Anesthesia

General.

Procedure

1.  A mouth gag is inserted.

2.  The tonsil is held with tonsil holding forceps towards the midline.

3.  Incision made with curved scissor through mucous at the point of joining of anterior pillar and tonsil.

4.  Tonsil freed by blunt dissection.

5.  Bleeding vessel clamped and tied.

6.  Other tonsil also removed in similar manner.

7.  Gag removed after hemostasis.

Adenoidectomy 

Objective

•   Adenoids curetted with adenoid curette 

•   The instruments pressed hard against posterior pharyngeal wall

•   Downward sweep

•   Avoid contact with mucosa of pharynx.

Instruments

Tonsillectomy and Adenoidectomy set.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com