ent questions
TRANSCRIPT
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Specific Issues for Revision fess Surgery
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1. Observe available landmarks both radiographically and
clinically.
2. Moving first from anterior to posterior, check each sinus
for abnormality. 3. Define or create landmarks necessary to operate safely
on a sinus-by-sinus basis as the surgeon moves
posteriorly.
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4. The two most important landmarks are the followinga)
the maxillary antrostomy to define the lamina papyracea
and sphenoid sinus. b)The sphenoid sinus to define the
skull base 5. Repair abnormalities of the maxillary, lower ethmoid and
sphenoid sinus first.
6. Once skull base landmarks are defined, repair the upper
ethmoid and frontal sinuses in a posterior-to anterior
direction, ending with the frontal sinus.
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7. The same safety techniques for primary ESS apply for
revision ESS.
8. There is no easy revision surgery.
9. Revision surgery is a situation where part of or the wholemiddle turbinate may need removal.
10. Stenting may be necessary.
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Classification of Complications
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The category correctable with treatment consists of
orbital hematoma (postseptal), loss of vision, diplopia,
CSF leakage, meningitis, brain abscess, focal brain
hemorrhage, hemorrhage requiring transfusion,carotidartery injury, and epiphora.
Permanent major complications are blindness, diplopia,
central nervous system deficit, and death.
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What is atticotomy?
Limited portion of the external canal wall is
sacrificed
Small attic sac cholesteatoma exteriorized by
drilling the scutum to the limits of the sac.Defect is reconstructed with bones or cartilage
graft
For limited attic cholesteatoma confined tocentral epitympanum
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Identify the instrument
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COBLATOR
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WHAT IS COBLATION
Coblation is a unique method of rapid and
controlled removal of tissue at relatively low
temperatures (typically 40-70C) while
maintaining the integrity of surrounding tissue orstructures.
"Coblation" is a synthetic term that means "cold
"and "removal".
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Using radio frequency in a bipolar mode with a
conductive solution, such as saline, Coblation
energizes the ions in the saline to form a small
plasma field.
The plasma has enough energy to break the
tissue's molecular bonds, creating an ablative
path.
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The plasma's energized particles have sufficient
energy to break molecular bond within tissue,
causing tissue to dissolve at relatively low
temperatures (typically 40C to 70C).
The result is volumetric removal of target tissue
with minimal damage surrounding tissue.
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IDENTIFY THE INSTRUMENT
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IDENTIFY THE INSTRUMENT
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KOENIG TRACHEOSTOMY TUBE
Used in difficult airway
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IDENTIFY THE INSTRUMENT
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KERRISON S PUNCH
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Identify the instrument
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Trousseau tracheal dilator
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Identify the instrument
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Turbinectomy scissors
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Identify the instrument
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Asch forceps