ENT

ENT Surgery

•       Anatomy

o   Ossicles- malleus, incus, stapes

-Malleus: Bone shaped like a hammer or mallet. The handle-like part of the malleus is attached to the tympanic membrane. 

-Incus: bone-shaped anvil, an iron block used by a blacksmith to shape metal 

-Stapes: The innermost ossicle in the middle ear; transmits sound waves to the oval window of the inner ear

o   Tympanic membrane(eardrum): The separation between the outer and middle ear. The outer surface is covered with epithelium, the center layer is made of fibrous connective tissue, and the inner lining is a mucous membrane. Its disk-shaped, normally concave. The eardrum is pearly grey in color, translucent, and has shiny appearance.  

o   Nasopharynx, oropharynx, laryngopharynx

-Nasopharynx: The superior portion, located immediately behind the nasal cavity

-Oropharynx: The middle section, located posterior to the mouth

-Laryngopharynx: The most inferior portion that opens into the larynx toward the anterior and into the esophagus toward the posterior  

•       Instruments

Within ear surgery a # of plastics surgery instruments; instruments designed with a short fulcrum,long shanks and working tips

-Argon laser is especially useful in the middle ear for a stapedectomy and stapedotomy procedure

- A speculum holder may be used to free the surgeon’s hands, it attaches to the rail at the side of the operating table for stability, allows the surgeon to use both of their hands to operate in the external auditory canal

-Nerve stimulator for the identification of the facial and vestibulocochlear nerve

- The sponges that are typically used during ENT surgery are; cotton pledges, square 4x4 sponges, cottonoids, and lap sponges

-Power instruments, like rotating drill( osteon, ototome), may be used, could be either powered by electricity or pneumatically  

Knifes

An #15 scalpel blade is mounted on a #7 knife handle, often used for submucosal incision

For deeper dissection

-The Joseph knife

-Ballenger swivel knife

-Button knife

Elevators or dissectors

In ENT procedures elevators or dissectors are used to lift the periosteum of the submucosa from the surface of the bone of cartilage. The elevator is beveled but not sharp

-Cottle knife or elevator

-Lempert elevator

-freer elevator

-Penfield dissectors

Forceps

Used for grasping and modeling tissue. The tips of the forceps are cupped or beveled for cutting, or flat and serrated

-Takahashi ethmoid forceps

-Noyes alligator forceps

Rongeur

Used specifically to cut bone, they provide enough leverage to cut through bone. Rongeurs with long sharks are used to reach deeper into small spaces.

-Jansen-Middleton ronger

-Kerrison Rongeur

Gourge, Chisel and Osteotome

The gouge, chisel and osteotome are used with a small mallet to model nasal bone. The sharp end of the instrument is angled against the bone and lightly struck with the mallet. It cuts the tissue by increments, producing bone shavings, which are removed with a forcep.

Shaver and drills

A microdebrider is used to excise tissue during nasal and laryngeal surgery. They are small powered handpieces with rotating blades, the microdebrider removes small segments of tissue and suctions them in and removes blood and debris from the surgical field

•       Medications

The medications that are used for procedures of the nose, mouth and throat this includes regional anesthesia, vasoconstriction agents and decongestants. A local anesthetic with epinephrine is injected into the nasal mucosa and turbinated for nasal procedures. Cocaine in solution is used as a vasoconstrictive agent for the nose or larynx .

•       Diagnostic procedures/tests

Tuning fork; a small two-pronged metal device that 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

Audiometry a sophisticated method of testing a patient’s hearing, a machine that is capable of emitting a tone at serval different pitches and volumes

Otoscope; a handheld instrument that is used to view the external auditior canal

Computed tomography(CT) scan ; very accurate in defining bony structures

Computed axial tomography (CAT) scan: a noninvasive method of viewing the inside of the body

Magnetic resonance imaging (MRI): a noninvasive method of viewing the inside of the body

Electronystagmography(ENG) an exam that tests the balance mechanism in the inner ear.\

        Direct vision: highly effective method of examination the interior of the nose is direct vision, accomplished with the use of a lamp affixed to the examiner's

Mirror examination: the examination of the nasopharynx and posterior nasal cavity. The examiner is able to view the posterior nares, the tubinates, the posterior end of the vomer bone, and the outlet of the maxillary sinus

•       Surgical Procedures

o   Parotidectomy

The excision of a portion or all of the parotid gland; The surgery is performed to clear the ducts or, if too many stones are present

o   Tonsillectomy & Adenoidectomy

The palatine, or faucial, tonsils are the two ova; masses of lymphoid tissue called the tonsils, when the pharyngeal tonsils are enlarged, they are referred to as adenoids. Where the pharyngeal tonsils( adenoids) are a single mass of lymphatic tissue that’s embedded in the mucous membrane of the posterior wall of the nasopharynx.

o   Polypectomy

The surgical removal of a polys that originate from the mucous membrane, arise from the walls of the sinuses of the ostia and protrudes into the nasal passageway. Polyp is connected to the mucous membrane by a pedicle.  

o   UPPP ( Uvulopalatopharygnoplasty)

The reconstruction of the uvula and oropharynx , is performed to reduce and tighten oropharyngeal tissue, Performed to treat patients who suffer from sleep apnea

o   Tracheotomy

Is performed to provide a patient airway, The procedure can take place in the emergency room/ department, ICU or the operating room

o   Mastoidectomy

The removal of diseased bone, the mastoid air cells are the soft tissue lining the air cells of the mastoid.

Mastoiditis is a complication of acute otitis media. An ear infection that has not been cleared from the middle ear and may be forced into the mastoid air cells.

Cholesteatoma is formed when the epithelial air calls that would normally be shed through the eustachian tube that are unable to migrate out pf the middle ear cavity due to the blockage. Cholesteatoma is a benign cyst or tumor that fills the mastoid cavity and erodes the mastoid air cells, can damage the ossicles.

o   Myringotomy (PE tubes)

(bilateral myringotomy with pressure equalizing tubes)

Where a surgical opening is made in the tympanic membrane to release the fluid from the middle; allowing equalization of air pressure between the middle ear and the outside barometric pressure

o   Function Endoscopic Sinus Surgery (FESS)

A diagnostic procedure that uses to treat a variety of sinus disorders, anatomical defects, and inflammatory conditions; The Goal of the procedure is to reestablish normal breathing and the ability of mucus to be cleared from the sineses. This is due to the inflammation, the mucus cannot be cleared and is trapped within the sinus

o   Septoplasty/submucosal resection (SMR)

In a submucosal resection the mucous membrane lining the nasal cavity will be incised and the underlying perichondrium or periosteum lifted. The structure that are underlying the mucous membrane will be removed to help restore normal breathing.

Septoplasty; performed to straighten a deviated nasal septum, used to repair a perforated septum or one damaged by trauma