recent trends,dr.s,vijayasundaram,24.10.16
TRANSCRIPT
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RECENT TRENDSRECENT TRENDS IN IN
OTORHINOLARYNGOLOGY OTORHINOLARYNGOLOGYBy
Dr. Vijayasundaram ASSO PROF .
MGMCRI
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INTRODUCTIONINTRODUCTION
Diversity of subspecialitiesMultidisciplinary approachComputer guided surgeryAdvanced microsurgical techniques
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Digital Hearing AidsDigital Hearing Aids
Multiprogram device with self adaptationSignals processed to suppress noiseAmplify specific frequenciesProvides clear hearingEnhanced sound qualityGreatly reduced feedback & easy handling
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BAHABAHA
Direct bone conductionDirect vibration transmission pathThree modes of excitationParts of BAHAIndicationsContraindications
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Auditory Brainstem ImplantAuditory Brainstem Implant
Electrical stimulation of 2nd auditory neuronNeurofibromatosis type 2 & traumatic cases21 channel electrodes placed in brainstemBody level speech processorTransmission coil on the scalpImproves conversational ability
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Cochlear ImplantCochlear Implant
Latest C-II bionic ear implant90,000 updates/secStimulation rates of 91,000 pulses/secIn profoundly deaf patientsSingle & multichannel More speech understanding
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BiomaterialsBiomaterials
Silicone rubber (silastic)TeflonTORP & PORP Future implants-Biomimetics
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Meniere’s diseaseMeniere’s disease
• Endolymphatic sac decompression• Modification( of Portmann’s technique)• Transcanal gentamycin instillation• Selective vestibular neurectomy
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Virtual reality simulatorVirtual reality simulator
• Special helmet and glove for viewing• 3-D world view• Virtual patient- data set of CT & MRI• Virtual Otoscopy- Display of 3 diff. views• Endoscopic sinus simulator
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Facial Cosmetic SurgeryFacial Cosmetic Surgery
• Grafts• Tissue advancement techniques• Surgical decompression of facial nerve • Surgical rehabilitation of facial n.palsy• Non-specific techniques for neuromuscular
retraining
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Skull Base SurgeriesSkull Base Surgeries
• Fisch Infratemporal fossa approach• Posterior approach• Lateral approach• Combined
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Gallium ScanGallium Scan
• In Malignant Otitis externa• Stage I, II, III• Anti-pseudomonal antibiotics• Treatment duration depending on scan
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Approaches to CFRApproaches to CFR• Anterosup sinonasal Area – Lat Rhinotomy• Anterosup sinonasl area & Frontal sinus – Lat Rhinotomy
with Lymel Extension• Supr Sinonasal Area – Mid Facial Degloving • Angiofibroma with intracranial extension through
cribriform plate –Transcervical Transmandibular Transpalatal
• Benign Tumours Involving Cribriform plate with minimal exrension to orbit-Medial Maaxillectomy with microscope
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Eagle’s syndromeEagle’s syndrome
• Symptoms• Diagnosis by Digital Palpation, Intra-
anaesthetic solution injected.• Investigation –OPG, AP and Lat skull films• Treatment- Intra-oral & extra-oral approach
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External approaches External approaches Anterior Cricoid Split Laryngofissure with Posterior Cricoid Split Laryngotracheoplasty Myo-hyoid flap with temporary stent Sternomastoid-clavicular periosteal flap Laryngeal Reconstruction by Augmentation Resection of Cricoid with Thyro-Tracheal anastmosis Resection with end to end anastomosis (Grillo)
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StentsStents• Types : Finger Cots• Endotracheal Tubes• Montgomery T-Tubes• Artificial Support that maintains airway
patency• Sialastic Sheet Rolls• Aboulker Stent• Cotton – Lorenz Stent• Acrylic Stent
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Phonosurgical techniquesPhonosurgical techniques
Vocal cord medialisation• - Injection: Teflon, fat,collagen• - Thyroplasty• - Arytenoid adduction• - Reinnervation
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Contd..Contd..
Lateralization procedure• Laser aryteniodectomy/cordotomy• Cordopexy with/without arytenoid
removal• Woodman's operation• Reinnervation• Endoscopic Augmentation Technique
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Neck DissectionsNeck Dissections
• Radical Neck dissection• Modified Neck Dissection-Type I, II, III• Selective Neck Dissection Supraomohyoid neck dissection- Clearance of level I, II ,III ,IV
Lateral neck dissection-II, III ,IV & VI
- Central compartment dissection
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LaryngectomyLaryngectomy
Wide field laryngectomyConservation surgerySupraglottic laryngectomySupracricoid laryngectomyVertical hemilaryngectomyNear Total and Total Laryngectomy
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Provox 2 voice prosthesisProvox 2 voice prosthesis
• Latest voice rehabilitation prosthesis• Low resistance indwelling medical grade
silicone device• Prosthesis insertion tool & cleaning brush• Inserted through tracheostoma or mouth
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Flaps in Head & Neck Flaps in Head & Neck ReconstructionReconstruction
• Local flaps - Random - Axial pattern• Distant axial - Deltopectoral - Cervical - Occipitomastoid• Myocutaneous • Free - Free Jejunal flap
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