Sunday, May 20, 2018

Key Notes for Endoscopic sinus surgeries

Antihistamines have no role in treatment of nasal polyps unless these are associated with Allergic Rhinitis.

Doxycycline can be given as immunomodulator for 3 weeks in pre operative period.

Saline irrigation helps in pre operative period.

Omalizumab has been proven to bring down IgE levels significantly especially in severe resistant Asthma. (Targeted therapy).

Keep the heart rate low around 60 and blood pressure normal during surgery.

Topical decongestant with Adrenaline for 5-10 mins espl in a young patient reduces overall surgical time..

Maxillary antrostomy types

Type 1: normal opening
Type 2: where posterior Maxillary wall is flushed with Maxillary sinus opening.
Type 3: where antrostomy opening is flushed down till level of inferior turbinates
Type 4: Medial Maxillectomy

Ringer Lactate is more physiological than normal saline for nasal irrigation.

Frontal ostium boundaries are

Medial : Middle turbinate
Lateral: Orbit
Anterior : Frontal beak- safest for enlargement
Posterior : Supraorbital cell

Draft procedure

Type 1: simple opening frontal ostium
Type 2a : removing surrounding hypertrophied mucosa.
Type 2a: also includes drilling frontal beak.

Where supra orbital cell ends, Anterior ethmoidal artery is located.

70degree telescope is also known as skull base blade.

Best treatment of middle turbinates is to respect it.

Maxillary line or Medial orbital angle is very important Landmark as sphenoid opening is never above it.

Sphenoid osteum marks the posterior boundary of posterior ethmoids.

In severe polypsis, it's better to remove antero inferior part of middle turbinates as to deliver more topical steroids.

Sinus surgery is Surgery of landmarks.

Low Vit. D levels are associated with low immunity.

Important Landmark in revision FESS

1. Frontonasal process or frontal beak.
2. Middle meats antrostomy
3. Inferior turbinate
4. Laminar papyracea.
5. Choanae

Selective posterior neurectomy is good for naso ocular symptoms..

Saturday, February 24, 2018

Excision of Sebaceous cyst in submandibular area of neck through proximal neck crease incision.

Sebaceous cyst can form in any part of body where sebum (oily) glands are common. Often these are infected and their removal provide cure. Sebaceous cyst of face and neck assume special importance as scar mark could be unsightly. Surgeon utilized proximal neck incision to minimizes impact of scar during surgery.

Superficial Parotidectomy

Ear Bud related injury in the ear.

Blood seen coming from ear after this girl did self cleaning of ears with Q tips (ear buds)

Examination under Microscope shows injured outer ear canal and contused ear drum. 

Ear buds or Q tips are often thought to be instruments for cleaning ear.
These picture highlights the injury it can cause which can have grave consequences.

Friday, February 23, 2018

Mandibular Tori

Tori are bony outgrowth from hard palate (commonly) and also from mandible.  They rarely cause any trouble and need to be left as such.  

They are presume to be formed as a result of local bony stress and more common in Asian and Inuit countries.

Mandibular Tori- happends because of local stress point. 

Thursday, February 15, 2018

Fluid in middle ear because of Barotrauma after a flight.

Note air bubbles and fluid in middle ear rotating with Valsalva maneuver. This lady complained of severe pain in right ear with landing of air plane.

In this age of increased air travel, barotrauma of ear is very common. Person complains of severe earache and sometimes decreased hearing often during descent of a plane. This case demonstrate the fluid formation of a lady after a flight.