Summary

This presentation details various aspects of Otorhinolaryngology (ENT) surgery. It outlines learning outcomes, anatomy of the ear, nose, and throat, perioperative considerations, surgical instrumentation, different surgical procedures, and references.

Full Transcript

Otorhinolaryngology Surgery Surgery in/on the human ear, nose, and throat Learning Outcomes ▪ Describe the anatomy of the ears, nose, throat ▪ Explain relevant surgical interventions and procedural considerations for ENT procedures Anatomy – Ear Anatomy - Ear ▪ E...

Otorhinolaryngology Surgery Surgery in/on the human ear, nose, and throat Learning Outcomes ▪ Describe the anatomy of the ears, nose, throat ▪ Explain relevant surgical interventions and procedural considerations for ENT procedures Anatomy – Ear Anatomy - Ear ▪ External Ear – Auricle – External auditory canal (cartilage and skin) – Tympanic Membrane ▪ Middle Ear – Eustachian tube – Ossicles (Malleus, Incus, Stapes) ▪ Inner Ear – Cochlea – Vestibular labyrinth Perioperative Nursing Considerations ▪ Facial nerve monitoring ▪ Position – Supine with shoulder roll ▪ Prepping – Povidone-iodine solution – Chlorhexidine is ototoxic ▪ Draping ▪ Surgical microscope Ear Instrumentation Ear Instrumentation Ear Surgery ▪ Myringotomy ▪ Mastoidectomy ▪ Tympanoplasty ▪ Cochlear Implant Myringotomy ▪ Indicated for acute otitis media with no response to antibiotics ▪ Incision in _______________ ▪ Aspiration of fluid under pressure ▪ Myringotomy tube inserted and left in place ▪ Falls out naturally when ear drum heals ▪ Antibiotic drops instilled post-op Myringotomy Middle Ear Surgery ▪ Tympanoplasty ▪ Mastoidectomy ▪ Stapedectomy Mastoidectomy ▪ Removal of diseased bone of the mastoid to treat cholesteatoma ▪ Eardrum incised to drain the middle ear ▪ Topical antibiotics are then placed in the ear Tympanoplasty ▪ Repair of tympanic membrane for ________ hearing loss or perforation ▪ Graft taken from the ear lobe, back of the ear, or tragus ▪ Post op packing of ear with antibiotic ointment ▪ Microscope required Cochlear Implant ▪ For _________ hearing loss ▪ Hearing aid implant in cochlea – Osseointegrated bone- anchored ▪ External sound processor sits above the skin behind the ear Cochlear Implant Nasal Surgery Nose ▪ Supported by cartilage and bone ▪ Two external nares for air passage into nasal cavity ▪ Humidifies and filters the air ▪ Nasal septum – Nasal Cartilage – Perpendicular plate of the ethmoid bones – Vomer bone Anatomy - Nose Nasal Sinuses ▪ Frontal sinus ▪ Ethmoid sinus ▪ Sphenoid sinus ▪ Maxillary sinus Perioperative Nursing Considerations ▪ Position – Supine – Semi Fowlers or Fowlers in recovery to decreasing swelling, and improve breathing/drainage ▪ Local: Topical epinephrine on patties to control bleeding ▪ Throat pack ▪ Nasal packing ▪ Moustache dressing ▪ MIS approach available – Sinuscope Webrils or Neuro Patties used with topical epinephrine are packed in the nose prior to prepping to allow for effective vasoconstriction of tissues before surgical incision. Rhinosurgery Instrumentation Rhinosurgery ▪ Functional Endoscopic Sinus Surgery (FESS) ▪ Closed Reduction of Nasal Fracture ▪ Nasoseptoplasty Rhinosurgery Instrumentation Functional Endoscopic Sinus Surgery (FESS) ▪ Endoscopic surgery through nasal cavity and into sinuses ▪ Goal is to drain sinuses by resecting tissue and creating aeration Purpose: Polyps Sinus Blockages Allergies (many years) FESS Closed Reduction of Nasal Fracture ▪ Manual realignment without incision ▪ Nasal packing or Denver split applied Nasoseptoplasty ▪ Deviated septum causing nasal obstruction ▪ Straightening of the cartilaginous or osseous segments of the septum ▪ Goal: Remove obstruction to improve air entry from nasal cavity ▪ Splints insitu for a few days Throat Surgery Anatomy - Throat ▪ Oral Cavity – Mouth – Salivary Glands ▪ Pharynx – Nasopharynx – Oropharynx – Hypopharynx ▪ Larynx – Laryngeal cartilages, ligaments, and muscles – Trachea Anatomy - Thyroid Anatomy - Thyroid ▪ Produce and releases hormones into the body ▪ Two lobes, joined by a ridge of thyroid tissue called isthmus ▪ Regulated by the pituitary gland, which sits at the base of the brain – If the level of thyroid hormone decreases, the pituitary gland produces thyroid stimulating hormone (TSH). – If the levels of thyroid hormones are too high, the pituitary attempts to decrease production by shutting off the TSH Anatomy – Parathyroid Gland ▪ Consists of four small, flat, yellow, ovoid masses ▪ Secretes parathyroid hormone (PTH) – Antagonist to calcitonin ▪ PTH regulates Calcium in the blood – Increase removal from bone storage – Increase absorption of calcium by intestines Perioperative Nursing Considerations ▪ Position – Supine head in gel ring – Head extended with sandbag/shoulder roll under shoulders ▪ Drain ▪ Lowers, ties (silk) major vessels ▪ Hemoclips ▪ Nerve stimulator ▪ Small scissors ▪ Vessel loops to isolate major vessels Throat Surgery ▪ Laryngoscopy ▪ Tonsillectomy ▪ Thyroidectomy ▪ Parotidectomy ▪ Radical Neck Dissection ▪ Tracheostomy Laryngologic Surgeries Laryngoscopy ▪ Visualize the glottis or vocal cords ▪ Use laryngoscope – Rigid, lighted speculum Oral Cavity Surgeries Tonsillectomy ▪ Removal of tonsils for chronic tonsillitis ▪ Adenoidectomy is often done at the same time Neck Surgery - Thyroidectomy ▪ Removal of the thyroid gland – Partial (various types) – Total thyroidectomy ▪ Parathyroid glands may be preserved and reimplanted if there is remaining thyroid ▪ Risk of injury to recurrent laryngeal nerves = damage to voice box Thyroidectomy Parotidectomy ▪ Removal of one or more parotid glands ▪ Usually a benign tumor ▪ Risk of injury to facial nerve ▪ Drain inserted ▪ May experience post op paralysis Radical Neck Dissection ▪ Removal of malignant head and neck tissues ▪ Right or Left sided ▪ Radical: – Cervical nodes, fascia, the jugular vein, sternocleidomastoid muscle and 11th cranial nerve, mandible, maxilla, thyroid, and/or parotid. ▪ Patient may require reconstructive surgery – Free flap ▪ Non-radical (modified neck dissection) removal of cervical nodes and fascia ▪ Patient may experience facial numbness, difficulty swallowing, or aesthetic changes Intra-Oral Cancer ▪ Oral resection (mandible) plus radical neck dissection ▪ Commando Procedure ▪ Require Tracheostomy procedure before starting this procedure Procedure Considerations AIRWAY: Tracheostomy BEFORE the proposed neck dissection ▪ Position: ▪ Count: ▪ Instruments: Basic ENT tray, snaps, mosquitoes ▪ *15 blades ++++ ▪ Hemostasis: hemoclips, silk ties Vessel loops to isolate major vessels while identifying anatomy Nerve Stimulator Specimens Drain Tracheostomy ▪ Opening of the trachea and insertion of a cannula through the cricoid cartilage ▪ Elective or emergency ▪ Various size obturators & tracheostomy; confirm with surgeon ▪ **Test cuff for leaks with sterile water BEFORE passing to surgeon Tracheostomy Required for: Prolonged intubation during the course of a critical illness Severe neck or mouth injuries Foreign body occluding airway Inhalation burn Paralysis of the muscles that affect swallowing causing a danger of aspiration Long term unconsciousness or coma Tracheostomy Instrumentation Tracheal Dilator Tracheal Hook ▪ Absorbable sutures to close ▪ Nylon suture to secure trach tube Trach Tube & Obturator References ▪ Rothwell, J. (2022). Alexander’s Care of the Patient in Surgery (17th ed.) Mosby Elsevier. ▪ Tighe, S. (2015). Instrumentation for the Operating Room (9th ed.) Mosby. ▪ ORNAC Standards 2023 ▪ Mayo Foundation for Medical Education and Research (2021)

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