Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENT Secrets > Chapter 185 - Septoplasty, Turbinate surgery > Flashcards

Chapter 185 - Septoplasty, Turbinate surgery Flashcards

1
Q

Strut - what it is, why its important

A

1.cm dorsocaudal

Avoid loss of tip support, saddle nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What to do with excised cartilage

A

May replace into mucoperichondrial pocket to decrease septal perf risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Blood supply to IT

A

br of posterior lateral nasal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tip support maj/min

A

Major: septum, lower lateral cart, upper lat (attachments between these)

Minor: interdomal lig, dorsal septum, membranous septum, sesamoid, skin, SQ tissue of tip, maxillary spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nose in cleft lip/palate

A

I/L LLC displaced I/P/L
Nasal tip, caudal septum, columella toward non-cleft side
Bony septum toward cleft side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Common complications of untreated septal hematoma

A

Septal perf, Saddle nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What to do if afrin is injected into vessels

A

phentolamine (a blocker)

Oxymetazoline will cause HTN, vasoconstriction, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sx of TSS

A

high fever, vomiting, hypotension, diarrhea, rash, multiorgan failure
Due to TSST-1 toxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How many people have a deviated septum?

A

50%

most asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Killian vs Hemitransfixion vs Transfixion

A

Killian - past mucocutaneous junction, less risk of tip support loss?

Hemi- at mucocutaneous junction, better access to caudal septum, allows bilateral flap elevation

Transfixion - bilateral hemi, allows access to caudal, columella, medial crura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Steps to septoplasty

A
  • afrin spray, inject epi:lido bilateral in subperichondrial space
  • incision near caudal septum, subperichondrial flap
  • disarticulate septal cart, remove bony septum if necessary
  • resect septal cart (leave strut)
  • repair tears in flaps
  • consider replacing excised septum into mucoperichond pocket
  • close mucosal incision, quilt septum, splints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Postop care and instructions after septoplasty

A

May have congestion, pain, bloody drainage mild intermitt, fatigue. Also may have nausea, dry mouth, difficulty sleeping
ABX, analgesics, antiemetics
Moisten nasal cavities with saline, keep head elevated
Take a week off work/school
Light activity first week
Full activity 1-2 weeks
F/u in 1-2 weeks
Complete mucosal healing within 3-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risks of septoturbinoplasty

A

infection, bleed, dry/crust, persist congestion, hematoma/abscess, perf, scar, alter smell/taste, numb, CSF leak, cosmesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anatomy of IT

A

medial submucosal tissue - vein, erectile
lateral- glandular
Hasner’s valve (flap at NLD orifice) opens into inf meatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Max dose of lidocaine, bupivacaine, cocaine

A

Lido: 5 (without epi) 7 (with epi) mg/kg (some say 4/7.5)
Bupiv: 3mg/kg
Cocaine: 2-3 mg/kg or 200mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Amides vs Esters

A

Amide- metaolized in liver. Lidocaine, Bupivacaine. Almost never have allergic rxn (if so, likely to preservative)

Ester- met in liver and plasma, may have allergic rxn, ut still likely due to preservative. Cocaine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sx of local anesthetic toxicity

A
  • Sense of doom, HA, anxiety, palp, respiratory distress, HTN, restless, disorient, rambling speech, seizures, vomiting, tachy, sweat
  • THEN: LOC, apnea, bradycardia, hypotension, CV collapse
18
Q

prilocaine, banzocaine toxicities, how to treat the major one

A

Benzo 200mg, Prilo 7mg/kg
Methemoglobinemia - hypoxia, SOB, cyanosis, AMS, HA
arrythmia, seizure, coma, death
Pulse ox inaccurate
Tx- supp O2, slow IV influsion of 1-2 mg/kg 1% methylene blue

19
Q

Improving hemostasis in nasal surgery

A

Stop anti-coagulant meds 1-2 weeks before and after surgery
HOB elevated 30 deg during surg
Decongestants
Minimize mucosal trauma

20
Q

When congestion due to turbinate hypertrophy is better during the day

A

upright
exposure to steam
exercise

21
Q

When to do surgery on turbintes

A

Persistent sx affecting QOL

Despite steroids, a-histamine, saline, decong

22
Q

Treatment of ozena

A

(Empty Nose Syndrome)

Saline, topical ointments, augment inferolateral nasal wall

23
Q

When to consider middle turbinate surgery

A

Avoid if unnecessary because it helps with humidification, airflow, proper sinus drainage, olfaction

May reduce if polypoid degeneration or concha bullosa

24
Q

Internal nasal valve

A

Septum, head of inf turb, upper lateral cartilage

25
Q

External nasal valve

A

columella, lateral crus of LLC, nasal ala

26
Q

Congestion with nasal valve collapse: worse or better with exercise?

A

Worse

Better with breathe right strips or cottle maneuver

27
Q

Treatment of nasal valve collapse

A

Intranasal stent, Breathe Right
Spreader graft, flaring sutures, butterfly graft, batten graft, lateral crural strut graft, alar rim graft, bone anchored suture
Cartilage from septum, ear or rib

28
Q

Septal hematoma/abscess presentation

A

Acute congestion, pain, swelling, fever

Fluctuance of septum occluding nose

29
Q

Septal hematoma/abscess treatment

A

Immediate I&D (local or general)

nasal splints 1 wk (prevent recurrence)

30
Q

Presentation of septal perforation

A

whistling sound, dryness, crust, bleeding, pain, congestion, drain, ASx

31
Q

DDx septal perforation

A 
surgery
trauma
drug use
vasculitis
infxn
granulomatous disease
malignancy
32
Q

Treatment of septal perf

A

Cons: saline, ointment
Surg: silastic septal button or repair
If 5mm or less, primary repair with interpositional graft
If 0.5-2cm, open approach, local mucosal flaps
If >2cm, tough to repair

33
Q

Contraindications to septal perf repair

A

active cocaine abuse

active infection, inflammatory, malignant disease

34
Q

Causes of saddle nose

A

nasal trauma
aggressive surgery during hump reduction
inadequate dorsal strut in septoplasty

35
Q

Treatment of saddle nose deformity

A

Open

Augment area with conchal or rib cartilage (onlay technique)

36
Q

How old a child should be prior to septoplasty

A

16 (by then, nose development usually complete)

Can do turbinoplasty when younger, but be conservative

37
Q

When you may need to go from endonasal septoplasty to open

A

Deviation from midline in dorsal septum, septal angle, caudal septum, nasal spine

38
Q

How to correct deviation of dorsal septum, septal angle

A

shave, extended spreader grafts

39
Q

How to correct deviation of posterior septal angle

A

shave, reposition cartilage on nasal spine

40
Q

How to correct deviation of caudal septum

A

septal batten graft, reposition, tongue-in-groove technique, caudal septal extension graft

41
Q

Pros and cons to nasal splints after nasal surgery

A

Pros: eliminate dead space between flaps, prevent hematoma, enhance mucosal healing, prevent synechiae, stabilize remaining septal cartilage
Remove 1 wk after
Cons: discomfort, infection, studies don’t show major differences between splint and non-splint, so may not be necessary

42
Q

How nasal surgery impacts sleep disordered breathing

A

Improved CPAP compliance, subjective sleep sx, QOL

More likely to help if breathe right strips or topical decongestants help decrease snoring or improve sleep quality

ENT Secrets (79 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions