(Otorhinolaryngologic) Surgeries

Published on 05/05/2017 by admin

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Last modified 05/05/2017

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FIG. 7.6 Caldwell-Luc operation. (From Ignatavicius DD, Workman ML: Medical surgical nursing: critical thinking for collaborative care, ed 5, St Louis, 2006, Mosby.)
 
Surgical Mapping
Myringotomy

Instruments Important Anatomy Involved Pathophysiology
ENT tray:
Farrior speculum
Frazier suction
Myringotomy knife
Alligator forceps
Tympanic membrane Effusion in middle ear, caused by inflammation of mucosa
Microbiology/Wound Classification Skin Prep/Incision/Patient position Pharmacology
Indigenous flora present in external ear
Pseudomonas aeruginosa and Staphylococcus aureus
Class III (dirty)
Prep: none
Incision: vertical, into tympanic membrane
Position: supine head supported on doughnut headrest
General anesthesia given by mask (short procedure)
Hydrogen peroxide to loosen any hard wax (cerumen) before incision
Go ahead and use the template available on the Evolve Resources site to map the remaining procedures:
• Tympanoplasty
• Mastoidectomy
• Stapedectomy
• Cochlear implant

Nasal Procedures

Procedures

• Septoplasty
• Turbinectomy
• Nasal polypectomy
• Choanal atresia repair
• FESS (functional endoscopic sinus surgery)
• Caldwell-Luc antrostomy (a.k.a. nasal antrostomy; Fig. 7.6)
• Rhinoplasty

Additional Facts to Remember

Cocaine 4% is used as a topical anesthetic; it also acts as a vasoconstrictor.
• Any surgery performed through the nose is considered nonsterile, with a wound classification of class III (contaminated).
Repair of choanal atresia (congenital absence of an opening into the nasopharynx) is performed in pediatric patients. The condition is usually suspected if an 8F catheter cannot be inserted where the opening should be. A powered burr or microdebrider is used to make the repair.
• In Caldwell-Luc antrostomy, the incision is made above the canine and second molar.
• It is important to identify and avoid damaging the infraorbital nerve, which could result in blindness or infraorbital neuralgia, a painful disorder that may be misdiagnosed as migraine.
Absorbable sutures are used in these procedures.

Mapping

Here’s the mapping on a couple of nasal surgeries.
 
Surgical Mapping
Rhinoplasty

Instruments Important Anatomy Involved Pathophysiology
Basic nasal instrumentation
Nasal septum
Ethmoid and vomer bones
Deformity of external nose (traumatic, congenital, or disease-related)
Microbiology/Wound Classification Skin Prep/Incision/Patient position Pharmacology
Class III (dirty)
Prep: none
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