CHAPTER 17

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,

duplicated, or posted to a publicly accessible website, in whole or in part.

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.

CHAPTER 17

Otorhinolaryngologic Surgery

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3

Objectives• After studying this chapter, you will be able

to:– Recognize the relevant anatomy of the ear,

nose, and upper aerodigestive tract– Summarize the pathology that prompts

otorhinolaryngologic surgical intervention and the related terminology

– Determine any preoperative otorhinolaryngologic diagnostic procedures/tests


Objectives (cont’d.)– Determine any otorhinolaryngologic

preoperative and intraoperative preparation procedures

– Indicate the names and uses of otorhinolaryngologic instruments, supplies, and drugs

– Indicate the names and uses of special otorhinolaryngologic equipment

– Summarize the surgical steps of the otorhinolaryngologic procedures


Objectives (cont’d.)– Interpret the purpose and expected outcomes

of the otorhinolaryngologic procedures– Recognize the immediate postoperative care

and possible complications of the otorhinolaryngologic procedures

– Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the otorhinolaryngologic patient


Introduction to Otorhinolaryngologic Surgery

• Otorhinolaryngologic surgery – Ranges

• Simple procedures: myringotomy• Complex procedures: laryngectomy

– Involves treating diseases and trauma – Includes plastic surgery procedures that often

include microsurgery on very small structures


Ear Procedures• Many surgical options are available

– Correct deformities of the ear – Restore function of the ear


Diagnostic Procedures/Tests for the Ear

• Tuning fork – Small two-pronged metal device – 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– May be used intraoperatively on a patient

under local anesthesia to determine improvement


Diagnostic Procedures/Tests for the Ear (cont’d.)

• Audiometry– More sophisticated method of testing a

patient’s hearing• Audiometer

– Machine capable of emitting a tone at several different pitches and volumes

– Patient indicates to the examiner which sounds are heard



• Otoscope – Handheld, lighted instrument for viewing the

external auditory canal – Refer to Figure 17-1

• Computed tomography (CT) scan (i.e., computed axial tomography scan) and magnetic resonance imaging (MRI)– Specialized noninvasive methods of viewing

the inside of the body



• Tympanogram – Measures vibrations of the eardrum by

placing a probe against the tympanic membrane

• Electronystagmography (ENG) – Tests the balance mechanism in the inner ear

• Cool, then warm liquid is introduced into the ear canal

• Stimulates rapid eye movements


Routine Instruments, Equipment, and Supplies

• Basic ear procedure instrument tray– Refer to Figure 17-2

• Routine supplies– Refer to text


Practical Considerations• Operating room and equipment

– Prepared prior to the arrival of the patient• Microscope

– Preparatory steps must be followed for use• Ear surgery preparation

– Operating table is reversed• Refer to Figure 17-3

– Patient position: supine


Practical Considerations (cont’d.)• Anesthesia

– Usually general anesthesia supplemented with a local anesthetic with epinephrine

• Draping– May be extensive: head wrap, towels, ear

drape, etc.• Dressing

– May be a very simple (e.g., cotton ball) or quite complex (e.g., mastoid)


Practical Considerations (cont’d.)• Repair or replacement of damaged or

diseased ossicles or the tympanic membrane– Several options

• Autografts (from the same person)• Allografts (from the same species)• Xenografts (from animals)• Synthetic grafts


Procedures• Include:

– Myringotomy – Tympanoplasty– Mastoidectomy– Stapedectomy– Cochlear implant


Nasal Procedures• Nose

– Facial feature – Serves at the organ for the sense of smell and

as the upper portion of the respiratory system• Nose and paranasal sinuses

– Prone to suffer several types of pathological conditions


Nasal Diagnostic Procedures/Tests • Diagnostic approaches to nasal and

paranasal sinus pathology– Direct vision– Mirror examination– Radiograph



• Instrumentation for rhinoplasty – Differs from the instrumentation for internal

nasal and sinus surgery• Endoscopic sinus surgery

– Requires specialized instrumentation and auxiliary equipment

• Sample nasal instrument set– Refer to Table 17-1


Routine Instruments, Equipment, and Supplies (cont’d.)

• Routine equipment– Headlamp– Electrosurgery unit (ESU) – Power drill– Insulated ESU with suction attachment– Bipolar unit



• Routine supplies– Basic back table pack– Bar drape and U-drape– Prep and basin set– Gloves– No. 10 and No. 15 knife blades– ESU pencil– Bipolar forceps– Suction system


Practical Considerations• Patient positioning

– Supine position with the head placed in a donut or foam headrest, or a roll placed under the scapular region

• Planned local anesthetic– Anesthesia provider will not be in attendance– Use of a small table (prep stand) or second

Mayo stand may be requested to hold the supplies for administration


Practical Considerations (cont’d.)• Eyewear

– Provisions to protect and prevent drying of the patient’s eyes should be made

• Facial hair– Removal is usually not necessary

• Draping – May include a turban-style wrap, wound

towels, bar sheet, and split sheet or U-drape


Practical Considerations (cont’d.)• Following nasal procedures

– Nose may be packed with gauze, which may be dry or impregnated with ointment

• Nose and sinus surgery – Generally done on an outpatient basis

• Procedures performed through the nose– Not considered sterile procedures


Submucous Resection (SMR)• Mucous membrane lining the nasal cavity

will be incised – Underlying perichondrium or periosteum lifted– Structures underlying the mucous membrane

will be removed to help restore normal breathing

– Mucous membrane is then laid back into position and held there with nasal packing material


SMR/Septoplasty• Purposes

– Straighten a deviated nasal septum– Repair a perforated septum or one damaged

by trauma• Submucosal approach is used

– Cartilaginous or osseous portion of the septum causing nasal obstruction is removed, readjusted, or reinserted



– SMR/septoplasty– Turbinectomy– Polypectomy– Choanal atresia repair– Functional endoscopic sinus surgery (FESS)– Intranasal antrostomy– Caldwell-Luc


Oral Cavity and Throat Procedures• Oral cavity and throat

– Consist of several individual and specialized structures that work in harmony to facilitate respiration and ingestion of food

• Pharynx, larynx, trachea, and esophagus– Can be affected by several conditions

• Range from minor inflammatory to malignancy as well as mechanical disorders


Diagnostic Procedures/Tests for the Oral Cavity and Throat

• Include:– Direct and indirect visualization– Laboratory tests

• Culture and sensitivity• Blood count

– Radiologic examinations• X-rays• CT scans• MRI


Diagnostic Procedures/Tests for the Oral Cavity and Throat (cont’d.)– Videostroboscopy– Polysomnography– Multiple Sleep Latency Test (MSLT)



• Instrumentation used for oral cavity and throat procedures – General surgery major instrument tray with

add-ons such as skin hook retractors• Exceptions are tonsillectomy and adenoidectomy,

and tracheostomy instrument trays: refer to Tables 17-2 and 17-3

– Some health care facilities may have a specialty neck instrument tray



• Operating microscope – Critical part of laryngeal surgery

• Refer to Figure 17-26

• Laser surgery – Becoming common in procedures involving

the larynx and oropharynx



• Additional important components– Illumination devices and sitting stools– # No. 12 knife blade– Endoscopes, laryngoscopes, bronchoscopes,

and esophagoscopes– Video equipment– Insulated electrosurgical devices– Histological stains and topical anesthetics – Lukens tubes


Practical Considerations• Patient positioning

– Depends on the patient’s age, type of surgery, and type of anesthetic

– Majority will be supine• General anesthesia

– Usually the anesthesia of choice– May be supplemented with a local or topical

anesthetic


Practical Considerations (cont’d.)• Supplies

– Medicine cups, syringes, and needles– Cotton tip applicators– Anesthetic of choice– Atomizer– Tongue blades– Laryngeal mirror– Small basin of warm water– Gauze sponges



– Tonsillectomy and adenoidectomy– Parotidectomy– Uvulopalatopharyngoplasty (UPPP)– Laryngectomy– Radical neck dissection with mandibulectomy– Temporomandibular joint arthroscopy– Tracheotomy


Summary• This chapter reviewed:

– Anatomy of the ear, nose, and upper aerodigestive tract

– The pathology that prompts otorhinolaryngologic surgical intervention

– Otorhinolaryngologic diagnostic procedures/tests

– Otorhinolaryngologic instruments and supplies– Otorhinolaryngologic procedures

CHAPTER 17

Documents

Transcript of CHAPTER 17