ENT Procedure 17 subandiblar gland excision

Excision of the Submaxillary (Submandibular) Gland

Objective

In cases of sialadenitis:

•   Excision of the submaxillary gland.

Position

Supine.

Anesthesia

General.

Procedure

1.  Transverse incision over the gland.

2.  Structures to be proteced are the mandibular branch of the facial nerve, the lingual nerve and hypoglossal nerve.

3.  The anterior facial vein is divided.

4.  The gland is dissected free of surrounding tissues.

5.  The facial artery is ligated.

6.  Wharton’s duct is identified adjacent to the lingual nerve, ligated and divided.

7.  Wound is closed in layers.

8.  A closed suction drain is employed.

Instruments

•   Plastic procedures set

•   Extra mosquito clamps   6

•   Lacrimal duct probes available

•   Basin set

•   Suction tubing

•   Blades (2) No. 15

•   Needle magnet or counter

•   Dissectors (e.g. peanut)

•   Drainage unit (e.g. Hemovac)

•   Bulb syringe

•    Nerve stimulator (locator)(optional)

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ENT Procedure 16 radical neck dissection

Radial Neck Dissection

Objective

In cases of cancer of head and neck:

•   Excision of cervical lymph node and adjacent muscular and vascular structures.

Position

Supine.

Anesthesia

General.

Procedure

   1.  Incision (Y, double, T, parelle-transverse, Z) in the lateral neck usually beneath the jaw to the supraclavicular region.

   2.  Skin flaps are mobilized.

   3.  The external jugular vein is severed.

   4.  The deep cervical fascia is incised (including some cuta­neous nerve branches).

   5.  The sternoclavicle origins of the sternomastoid muscle are divided.

   6.  The internal jugular vein is isolated and divided.

   7.  The omohyoid muscle is transected.

   8.  Fatty tissues bearing lymph nodes are dissected from underlying structures in continuity.

   9.  The insertion of the sternomastoid muscle is divided.

10.  The lower pole of the parotid gland removed, no injury to branches of the facial nerve.

11.  The facial artery and vein are divided, and the submaxillary gland and proximal end of the internal jugular vein are divided.

12.  The tissue bloc is then excised.

13.  The accessory nerve is preserved on the left, the thoracic duct is protected.

14.  The flaps are closed over suction drains.

15.  A moderate pressure dressing is applied.

Instruments

•   Minor procedure set

•   Thyroid set

•   Tracheostomy set

•   Extra mosquito clamps (24)

•   Extra towel clips (8)

•   Right angle clamps (finely pointed)

•   Basin set

•   Marking pen

•   Suction tubing

•   Blades (2) No. 10 (3) No. 15

•   Dissector (e.g. peanut)

•   Bulb syringe (2)

•   Umbilical tapes, vessel loops

•   Nerve stimulator (locator)

•   Suction drainage unit (e.g. Hemovac).

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ENT Procedure 15 parotidectomy

Parotidectomy

Objective

In cases of disease of Parotid:

•   Excision of all or superficial portion of the salivary gland.

Position

Supine.

Anesthesia

General.

Procedure

1.  An incision in the preauricular region, continued inferiorly around the earlobe, and then anteriorly along sternomastoid.

2.  The fascia is incised.

3.  Careful exposure of the facial nerve is necessary.

4.  A nerve stimulator can be used to help in its identification.

5.  The superficial portion of the gland may be resected after blunt and sharp dissection.

6.  Removal of the deeper portion may be necessary for malignancy.

7.  Stenson’s duct is ligated and divided.

8.  The wound is closed often employing a drain.

Instruments

•   Minor procedure set 

•   Thyroid set 

•   Extra right-angle clamps 

•   Nerve hook 

•   Basin set 

•   Blades (1) No. 10 (3) No. 15 

•   Suction tubing 

•   Dissector (e.g. peanut) 

•   Bulb syringe 

•   Marking pen 

•   Drain (e.g. 1/4" Penrose, Hemovac) 

•   Sterile, plastic adhesive drape (optional) 

•   Nerve stimulator (locator)

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ENT Procedures 14 drainage of frontal sinus

Drainage of the infected frontal sinus.

Position

Supine.

Anesthesia

General.

Procedure

1.  Incision along the inferior margin of the eyebrow.

2.  The periosteum is reflected.

3.  Ethmoid sinus entered.

4.  The frontal sinus is entered after bone is rongeured.

5.  Removing the floor of the sinus.

6.  Diseased mucous membrane is excised using curettes, periosteal elevators and pituitary forceps.

7.  A nasofrontal passage is made by removing a portion of the middle turbinate.

8.  External wound is closed and dressed.

Instruments

•   Nasal set

•   Minor procedure set

•   Weitlaner self-retaining retractor

•   Power saw (e.g. Stryker), with oscillating blade and cord

•   Basin set

•   Suction tubing

•   Blades (2) No. 15

•   Bulb syringe

•   Drain

•   Nasal packing.

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ENT PROCEDURE 13 polypectomy

Nasal Polypectomy

Objective

In cases of nasal polyps

•   Excision of hypertrophied nasal mucosa.

Position

Supine.

Anesthesia

Local.

Procedure

1.  Polyps are individually encircled with a wire of a nasal polyp snare.

2.  Grasped with forceps, and amputated.

3.  Nasal cavity is packed with a vaseline gauze.

Instruments

•   Nasal set

•   Minor procedure set

•   Metal tongue depressor

•   Poly forceps

•   Nasal snare with wires

•   Basin set

•   Blades (1) No. 15

•   Cotton tipped applicators (long)

•           Nasal packing vaseline gauze

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