Chapter 17: Otorhinolaryngologic Surgery; Short Answer: Nasal Surgery

What causes the nasal septum to deviate from the midline?

Aging, trauma

Prior to the case, a separate small setup may be used to prepare the site and provide analgesia and hemostasis. What is used for the setup?

Extra Mayo, nasal speculum, bayonet forceps, local anesthetic with epinephrine, 10mL Luer-lock syringe with 25 gauge needles, cocaine and/or oxymetazoline, cottonoids.

Why do you think bayonet-style forceps would be used for a deep hole such as a nostril?

They are thin and long, allowing them to reach through a deep hole without punching structures.

If the case is posted as a septoplasty/septorhinoplasty, what procedure(s) would be done during the case?

Septoplasty, rhinoplasty, mentoplasty

What will be included in the postoperative dressings for a septoplasty?

Internal and external splints with a "mustache" dressing. Metal and fiberglass splint.

Why is the wound classification a clean-contaminated (II) case?

The nose is a place of controlled entry into the aerodigestive tract.

Why are the conchae (turbinates) removed? Which set is most commonly transected?

Hypertrophied turbinates may occur as a result of chronic rhinitis; the inferior turbinates are most often removed.

What are the more common methods of removal of the turbinates?

Inferior turbinectomy, Microdebrider, Turbinectomy, Laser Turbinectomy.

polyps can occur anywhere there is a mucous membrane along the GI tract and in the sinuses. What is frequently used to remove a polyp?

Treatment with steroids surgical removal with polyp share.

Define choanal atresia.

Congenital defect caused by failure of the nasopharyngeal septum to rupture during embryonic development.

Identify the difference between the two main techniques used to repair a choanal atresia.

Transseptal: Incision into septum to visualize bony and/or membranous obstruction.

Endoscopic: Endoscope inserted endonasally with its angle directed inferiorly.

Name the four paranasal sinuses. These sinuses have openings that can become infected when the mucous membranes swell with chronic inflammation and close off the area, creating a mucocele. What are the openings called?

Frontal sinuses: Behind the eyebrows.

Ethmoid sinuses: Between the eyes.

Sphenoid sinuses: Behind the nose.

Maxillary sinuses: Below the eyes.

Sometimes the enlargement of the Ostia is necessary; what should be used during a functional endoscopic sinus surgery (FESS)?

Basic nasal set, endoscopic instruments, endoscopic video equipment, camera, sinuscope light cord, 4 or 5mm sinuscopes, 0-, 30-, 70-, 90-, and 120- degree lenses, antifog, suction-irrigation, navigational system, antrum punch, spoon, or probe will be used. Antrum trocar or rasp is used to make an intranasal window.

There are dangers regarding sinus surgery due to the proximity for the sinus cavity to the orbits. What should the surgical team be looking for on the monitor?

If the orbit is accidentally entered, it can be confirmed by the presence of the yellow orbital fat on the monitor. If any member of the surgical team views this on the monitor, the surgeon should be told immediately.

If a Caldwell-Luc is necessary due to tumors or problems with access from the nasal cavity, where is the incision made? When the incision is made, why is great care required?

Suculus incision: the gingiva above the canine tooth and second molar. Great care is given to the infraorbital nerve needing to be identified and retracted.