بسم الله الرحمن الرحيم. ENT Surgical Procedures Ear Operations.

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


• Infection

• Blockage


• Infection

• Blockage

• Early extrusion


• Infection

• Blockage

• Early extrusion

• Tympanoscleosi

s


• 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)

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


• Suspected malignancy

INDICATIONS



• Repeated attacks of tonsillitis

• Chronic tonsillitis

• One attack of quinsy (peritnosillar

abscess)

INDICATIONS



• 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

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

http://nosephotographs.hawkelibrary.com/album83/Atrophic_Rhinitis_Case_14?full=1

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

بسم الله الرحمن الرحيم. ENT Surgical Procedures Ear Operations.

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