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الرحيم الرحمن الله بسم
ENT Surgical Procedures
Ear Operations
Myrigotomy
Indications of myringotomy
• AOM with bulging TM
– Relieve pain
– C & S
– To produce a clean cut
incision which is more
likely to heal
spontaneously
Indications of myringotomy
• AOM with bulging TM
• Insertion of Ventilation tube (Grommet tube)
Indications of Ventilation Tube Insertion
• Otitis Media with
Effusion
• Repeated attacks of
acute otitis media
Complications of myringotomy
• Injury to incudostapedial
Joint
• Bleeding (high dehiscent
jugular bulb)
Complications of Ventilation Tubes
• Infection
Complications of Ventilation Tubes
• Infection
• Blockage
Complications of Ventilation Tubes
• Infection
• Blockage
• Early extrusion
Complications of Ventilation Tubes
• Infection
• Blockage
• Early extrusion
• Tympanoscleosi
s
Complications of Ventilation Tubes
• Infection
• Blockage
• Early extrusion
• Tympanosclerosis
• Persistent perforation
Myringoplasty
• An operation
performed to repair
the tympanic
membrane
Tympanoplasty
• An operation
performed to repair
the tympanic cavity
(TM and/or the
ossicles)
Indications
• Chronic infections (CSOM)
• Trauma
• Congenital (not common)
Aims of Tympanoplasty and Myringoplasty
• To close the perforation
• To prevent re-infection
• To improve hearing
CORTICAL MASTOIDECTOMY
An operation
performed to covert
the mastoid antrum
and air cells into one
cavity, without
disturbing the existing
middle ear content
Aim
• Drainage
Indications of cortical mastoidectomy
• Acute mastoiditis not responding to medical treatment
• Mastoid abscess
Technique of Cortical Mastoidectomy
Radical & Modified Radical Mastoidectomy
RadicalAn operation in which the mastoid antrum and middle ear and the external canal are converted into common cavity. The tympanic membrane, malleus and incus are removed leaving only the stapes in situ.
Modified RadicalAn operation in which
the mastoid antrum and middle ear and the external canal are converted into common cavity. The tympanic membrane and ossicles remnants are retained
Indication
• CSOM with Cholesteatoma (attico-antral or the unsafe type)
Indication
• CSOM with Cholesteatoma (attico-antral or the unsafe type)
Aims of radical & modified radical mastoidectomy
• Remove cholesteatoma to provide
– Safety
– Dry ear
– Preserve hearing
Complications of Tympanoplasty & Mastoidectomy
• Facial nerve injury
• Inner ear trauma
• Other complications– Chorda tympani injury– Hemorrahge, infection etc
The Pharynx
Adenoidectomy
Indication
• Large and/or chronically infected adenoid causing symptoms or complications
General Contraindications
• Bleeding tendency
• Recent URTI
Local Contraindication
Palatopharyngeal incompetence
TONSILLECTOMY
INDICATIONS
• Obstructing tonsillar enlargement
INDICATIONS
• Obstructing tonsillar enlargement
• Suspected malignancy
INDICATIONS
• Obstructing tonsillar enlargement
• Suspected malignancy
• Repeated attacks of tonsillitis
• Chronic tonsillitis
• One attack of quinsy (peritnosillar
abscess)
INDICATIONS
• Obstructing tonsillar enlargement
• Suspected malignancy
• Repeated attacks of tonsillitis
• Chronic tonsillitis
• One attack of quinsy (peritnosillar
abscess)
• Others
CONTRAINDICATIONS
• Bleeding tendency
• Recent URTI
COMPLICATIONS
• Hemorrhage– Primary
– Reactionary
– Secondary
• Respiratory obstruction
• Injury to near-by structures
• Pulmonary and distant infections
Primary Hemorrhage
• Bleeding occurring during the surgery
• Causes– Bleeding tendency– Acute infections– Bad technique
• Management– General supportive measures– Diathermy, ligature or stitches– Packing
Reactionary Hemorrhage
• Bleeding occurring within the first 24 hours postoperative period
• Causes– Bleeding tendency– Slipped ligature
• Diagnosis– Rising pulse & dropping blood pressure– Rattle breathing– Blood trickling from the mouth– Frequent swallowing– Examination
Reactionary Hemorrhage
• Treatment
– General supportive measures
– Take patient back to OR
– Control like reactionary hemorrhage
Secondary hemorrhage
• Occur 5-10 days posoperatively
• Due to infection
• Treated by antibiotics
• May need diathermy or packing
Sinonasal Surgery
Closed reduction of fracture nasal bone
Closed reduction of fracture nasal bone
Septoplasty
Indications
• Deviated septum causing symptoms or complications
Septoplasty
Rhinoplasty
• An operation to correct external
nasal deformity for functional and/or
cosmotic purposes.
Complications of Septoplasty and/or Rhinoplasty
• Septal hematoma
& abscess
• Septal perforation
• Nasal deformity
• Synechia
(adhesion)
The Turbinates
Causes of turbinate enlargement
• Physiological enlargement (nasal cycle)
• Acute rhinitis
• Chronic allergic and non-allergic rhinitis
• Deviated nasal septum (compensatory
enlargement)
Surgical treatment of obstructing turbinates
• Partial inferior turbinectomy & turbinoplasty
Surgical treatment of obstructing turbinates
• Partial inferior turbinectomy & turbinoplasty
• Electrocautery, Cryosurgery, Laser Surgery• Submucous Diathermy
Complications
• Bleeding
• Synechia (adhesion)
• Atrophic rhinitis
FESS
• Functional Endoscopic Sinus Surgery– Endoscopic surgery in the paranasal
sinus aims at preserving the “function” of the sinuses
Indications
• Chronic sinusitis not responding to
medical treatment
• Sino-nasal polyposis
• Others
– Tumors
– CSF rhinorrhea
Complications
• Synechia
• Bleeding
• Orbital complications (hematoma,
optic nerve injury, etc)
Complications
• Synechia
• Bleeding
• Orbital complications (hematoma, optic
nerve injury, etc)
• Cranial and intracranial complications
(CSF rhinorrhea, meningitis etc)
Endoscopy
Endoscopy
• Pharyngoscopy
• Esophogoscopy
• Laryngoscopy
• Bronchoscopy
General Indications
• Diagnostic
– Hoarseness, dysphagia, hemoptsis etc
– Biopsy
• Therapeutics
• FB removal
• Dilatation of stricture
• Removal of benign tumors
Types
• Flexible
• Rigid
Flexible naso-pharyngo-laryngoscopy
Direct Rigid Laryngoscopy
DedoJako Jackson
Direct Laryngoscopy
Microlayngoscopy
Rigid Bronchoscopy
Flexible Bronchoscopy
Flexible Esophagoscopy
Rigid Esophagoscopy
Complications of endoscopy
• Bleeding
• Swelling of the mucosa of the
targeted organ
• Rupture of the wall
• Injury to near by-structure
THANK YOU
Yousry El-Sayedhttp://faculty.ksu.edu.sa/
yousryelsayed
