ENT Surgery Flashcards
4 sinus compartments
- ethmoid
- maxillary
- frontal
- sphenoid
**susceptible to trauma
nasal turbinate
- lateral aspect
- increase surface area
- highly vascularized
3 parts of pharynx
- naso
- oral
- hypo
nerve supply to airway
CN 5: trigeminal (ophthalmic, maxillary, mandibular)
CN 9: glossopharyngeal
CN 10: vagus
palatine tonsils
- very vascular: external carotid, maxillary, facial arteries
- lymphatic system
branches of vagus nerve and innervation
- external superior - motor to cricothyroid
- internal superior - sensory to larynx above vocal cords
- recurrent - motor and sensory below vocal cords and motor to cricothyroid
larynx location - infant vs adult
- infant: C3-C5
- adult: C4-C6
narrowest part of larynx, age which this changes
- infant: cricoid ring
- adult: vocal cords
*at 8 years airway resembles adult
larynx unpaired cartilages
- thyroid
- cricoid
- epiglottis
larynx paired cartilages
- arytenoid
- cuneiform
- corniculate
hyoid bone
- u-shaped
- joins larynx to the tongue
glossopharyngeal
nerve
- superior aspect of epiglottis and base of tongue
- gag reflex
cases to avoid nitrous oxide
- ear procedures
- laser
- foreign body
considerations for ENT
- head of table turned 90-180 degrees
- NIM-EMG: nerve monitoring, *avoid muscle relaxation
- smooth and rapid emergence, *IV lidocaine
- avoid N2O
- minimize blood loss: use epi-cocaine local anesthetic, controlled hypotension (*vascular tumors)
complications for ENT
- n/v: suction out stomach, IVF, anti-emetics
- use opioids with caution in children with OSA
individuals with elevated oral secretions
- smokers
- African-Americans
max doses of epinephrine mixed with local anesthetic
- 200 mg
- 1.5 mcg/kg
IM dose - anectine
- 3-4 mg/kg
- 2-3 minutes to onset
sublingual dose - anectine
- 0.5-1 mg/kg
- 30 sec-1 min to onset
myringotomy and tube placement
- inhalation induction
- mask case
- no IV
- have IM anectine and atropine ready for all kids
tonsillectomy and adenoidectomy
“T-n-A”
- oral RAE (cuffed) versus LMA
- shoulder roll to extend neck
- throat pack: make sure it comes out
- suction stomach
- position on side post-op for drainage
complications - tonsillectomy and adenoidectomy
- laryngospasm: Larson maneuver, positive pressure ventilation, and SUX
- bleeding: RSI, replace blood, extubate fully awake
cleft lip and palate
- difficult intubation
- oral RAE
- NO oral airway, only nasal
- large amount of secretions post-op
acute epiglottitis signs
- 2-7 year old
- influenza B
- sitting position with head extended and leaning forward
- “thumb sign” on x-ray
acute epiglottitis treatment
- 100% O2
- do not do DL or sedation outside of OR
- keep patient calm
- downsize ETT by 1
- check for air leak prior to extubation
sinus and nasal surgery
- oral RAE
- increased bleeding
foreign body aspiration
- common in right mainstem
- @ larynx: DVL with magill forceps
- @ distal: bronchoscope
- spontaneous ventilation with no cricoid or positive pressure
- sitting position
- use TIVA
- check for airway edema prior to extubation
- no N2O
trach sizing
women: 6.0 shiley with 26 F dilator
male: 8.0 shiley with 28 F dilator
complications - radical neck
- carotid sinus stretch can elicit vagal response
- pneumothorax
- venous air embolism
- recurrent laryngeal nerve damage
- Q-T segment prolongation
- high circuit pressures
Le Fort facial fracture classification
I: horizontal, below nose to hard palate
II: U-shaped, under eyes to bridge of nose
III: separation of facial skeleton to cranium
facial fracture considerations
- no nasal airways
- considered to have cervical spine fracture until proven otherwise
- can be opened to brain
- need wire cutters at bedside if mouth is wired shut
nerve responsible for laryngospasms
superior laryngeal: internal sensory, external motor
