1. بسم الله الرحمن الرحيم

2. ENT Surgical Procedures

3. Ear Operations

4. Myrigotomy

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

6. Indications of myringotomy
AOM with bulging TM
Insertion of Ventilation tube (Grommet tube)

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

9. Complications of myringotomy
Injury to incudostapedial Joint
Bleeding (high dehiscent jugular bulb)

10. Complications of Ventilation Tubes
Infection

11. Complications of Ventilation Tubes
Infection
Blockage

12. Complications of Ventilation Tubes
Infection
Blockage
Early extrusion

13. Complications of Ventilation Tubes
Infection
Blockage
Early extrusion
Tympanoscleosis

14. Complications of Ventilation Tubes
Infection
Blockage
Early extrusion
Tympanosclerosis
Persistent perforation

15. Myringoplasty Tympanoplasty
An operation performed to repair the tympanic membrane
An operation performed to repair the tympanic cavity (TM and/or the ossicles)

16. Indications
Chronic infections (CSOM)
Trauma
Congenital (not common)

17. Aims of Tympanoplasty and Myringoplasty
To close the perforation
To prevent re-infection
To improve hearing

19. CORTICAL MASTOIDECTOMY
An operation performed to covert the mastoid antrum and air cells into one cavity, without disturbing the existing middle ear content

20. Aim
Drainage

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

22. Technique of Cortical Mastoidectomy

25. 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

27. Indication
CSOM with Cholesteatoma (attico-antral or the unsafe type)

28. Indication
CSOM with Cholesteatoma (attico-antral or the unsafe type)

30. Aims of radical & modified radical mastoidectomy
Remove cholesteatoma to provide
Safety
Dry ear
Preserve hearing

31. Complications of Tympanoplasty & Mastoidectomy
Facial nerve injury
Inner ear trauma
Other complications
Chorda tympani injury
Hemorrahge, infection etc

32. The Pharynx

33. Adenoidectomy

34. Indication
Large and/or chronically infected adenoid causing symptoms or complications

36. General Contraindications
Bleeding tendency
Recent URTI

37. Local Contraindication
Palatopharyngeal incompetence
Speech path consult for speech disorder.
Submucous cp 1 in 1200

39. TONSILLECTOMY

40. INDICATIONS
Obstructing tonsillar enlargement

41. INDICATIONS
Obstructing tonsillar enlargement
Suspected malignancy

42. INDICATIONS Obstructing tonsillar enlargement Suspected malignancy
Repeated attacks of tonsillitis
Chronic tonsillitis
One attack of quinsy (peritnosillar abscess)

44. INDICATIONS Obstructing tonsillar enlargement Suspected malignancy
Repeated attacks of tonsillitis
Chronic tonsillitis
One attack of quinsy (peritnosillar abscess)
Others

45. CONTRAINDICATIONS
Bleeding tendency
Recent URTI

46. COMPLICATIONS Hemorrhage Respiratory obstruction
Primary
Reactionary
Secondary
Respiratory obstruction
Injury to near-by structures
Pulmonary and distant infections

47. Primary Hemorrhage Bleeding occurring during the surgery Causes
Bleeding tendency
Acute infections
Bad technique
Management
General supportive measures
Diathermy, ligature or stitches
Packing

48. 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

49. Reactionary Hemorrhage
Treatment
General supportive measures
Take patient back to OR
Control like reactionary hemorrhage

50. Secondary hemorrhage Occur 5-10 days posoperatively Due to infection
Treated by antibiotics
May need diathermy or packing

51. Sinonasal Surgery

52. Closed reduction of fracture nasal bone

53. Closed reduction of fracture nasal bone

54. Septoplasty

55. Indications
Deviated septum causing symptoms or complications

56. Septoplasty

57. Rhinoplasty
An operation to correct external nasal deformity for functional and/or cosmotic purposes.

60. Complications of Septoplasty and/or Rhinoplasty
Septal hematoma & abscess
Septal perforation
Nasal deformity
Synechia (adhesion)

61. The Turbinates

62. Causes of turbinate enlargement
Physiological enlargement (nasal cycle)
Acute rhinitis
Chronic allergic and non-allergic rhinitis
Deviated nasal septum (compensatory enlargement)

64. Surgical treatment of obstructing turbinates
Partial inferior turbinectomy & turbinoplasty

65. Surgical treatment of obstructing turbinates
Partial inferior turbinectomy & turbinoplasty
Electrocautery, Cryosurgery, Laser Surgery
Submucous Diathermy

66. Complications
Bleeding
Synechia (adhesion)
Atrophic rhinitis

68. FESS Functional Endoscopic Sinus Surgery
Endoscopic surgery in the paranasal sinus aims at preserving the “function” of the sinuses

70. Indications Chronic sinusitis not responding to medical treatment
Sino-nasal polyposis
Others
Tumors
CSF rhinorrhea

71. Complications Synechia Bleeding
Orbital complications (hematoma, optic nerve injury, etc)

74. Complications Synechia Bleeding
Orbital complications (hematoma, optic nerve injury, etc)
Cranial and intracranial complications (CSF rhinorrhea, meningitis etc)

76. Endoscopy

77. Endoscopy
Pharyngoscopy
Esophogoscopy
Laryngoscopy
Bronchoscopy

78. General Indications Diagnostic Therapeutics
Hoarseness, dysphagia, hemoptsis etc
Biopsy
Therapeutics
FB removal
Dilatation of stricture
Removal of benign tumors

79. Types
Flexible
Rigid

80. Flexible naso-pharyngo-laryngoscopy

84. Direct Rigid Laryngoscopy

85. Dedo
Jackson
Jako

86. Direct Laryngoscopy

87. Microlayngoscopy

88. Rigid Bronchoscopy

90. Flexible Bronchoscopy

91. Flexible Esophagoscopy

92. Rigid Esophagoscopy

93. Complications of endoscopy
Bleeding
Swelling of the mucosa of the targeted organ
Rupture of the wall
Injury to near by-structure

94. Yousry El-Sayed http://faculty.ksu.edu.sa/yousryelsayed
THANK YOU
Yousry El-Sayed