ENT Surgical procedures

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

3. Ear Operations

4. Myrigotomy

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

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

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

9. Complications of Ventilation Tubes Insertion Infection

10. Complications of Ventilation Tubes Insertion Infection Blockage

11. Complications of Ventilation Tubes Insertion Infection Blockage Early extrusion

12. Complications of Ventilation Tubes Insertion Infection Blockage Early extrusion Tympanosclerosis

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

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

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

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

21. Technique of Cortical Mastoidectomy

23. 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

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

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

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

28. The Pharynx

29. Adenoidectomy

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

32. General Contraindications Bleeding tendency Recent URTI

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

36. TONSILLECTOMY

37. INDICATIONS Obstructing tonsillar enlargement

38. INDICATIONS Obstructing tonsillar enlargement Suspected malignancy

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

40. CONTRAINDICATIONS Bleeding tendency Recent URTI

42. Post tonsillectomy

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

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

45. 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

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

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

49. Sinonasal Surgery

50. Septoplasty

51. Indications Deviated septum causing symptoms or complications

52. Septoplasty

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

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

56. The Turbinates

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

59. Complications Bleeding Synechia (adhesion) Atrophic rhinitis

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

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

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

67. Endoscopy

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

69. Types Flexible Rigid

70. Flexible naso-pharyngo-laryngoscopy

73. Direct Rigid Laryngoscopy

75. Direct Laryngoscopy

76. Microlayngoscopy

77. Rigid Bronchoscopy

79. Flexible Bronchoscopy

80. Flexible Esophagoscopy

81. Rigid Esophagoscopy

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

83. THANK YOU