ENT Surgical procedures Dr. Manal Bukhari King Saud University Otolaryngology Assistant professor consultant Phonosurgeon King Abdulaziz University

Ear Operations

Myrigotomy

Indications of myringotomy AOM with bulging TM Relieve pain To produce a clean cut incision which is more likely to heal spontaneously

Indications of myringotomy AOM with bulging TM Insertion of Vetilation tube (Grommet tube)

Indications of Ventilation Tube Insertion Otitis Media with Effusion Repeated attacks of acute otitis media

Complications of Ventilation Tubes Insertion Infection

Complications of Ventilation Tubes Insertion Infection Blockage

Complications of Ventilation Tubes Insertion Infection Blockage Early extrusion

Complications of Ventilation Tubes Insertion Infection Blockage Early extrusion Tympanosclerosis

Complications of Ventilation Tubes Insertion Infection Blockage Early extrusion Tympanosclerosis Persistent perforation

Myringoplasty Tympanoplasty An operation performed to repair the tympanic membrane 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

Indications of cortical mastoidectomy Acute mastoiditis not responding to medical treatment Mastoid abscess

Technique of Cortical Mastoidectomy

Radical & Modified Radical Mastoidectomy Radical An 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 Radical An 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)

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 Speech path consult for speech disorder. Submucous cp 1 in 1200

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) Others

CONTRAINDICATIONS Bleeding tendency Recent URTI

Post tonsillectomy

COMPLICATIONS Hemorrhage Respiratory obstruction 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

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 or Rhinoplasty Septal hematoma & abscess Septal perforation Nasal deformity Synechia (adhesion)

The Turbinates

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) Cranial and intracranial complications (CSF rhinorrhea, meningitis etc)

Endoscopy

General Indications Diagnostic Therapeutics 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

Dedo Jackson Jako

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

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