Head & Neck Surgery: ENT (Exam II) Flashcards
What provides motor innervation to the intrinsic muscles of the larynx?
Right & Left Recurrent Laryngeal nerves
Which muscles are not innervated by the right and left recurrent laryngeal nerves?
- Cricothyroid
- Inferior pharyngeal constrictors
Sensory input for the right and left recurrent laryngeal nerves is provided from where?
- Below vocal cords & upper trachea
What occurs with bilateral recurrent laryngeal nerve injury?
Vocal Cord paralysis
What does the external branch of the superior laryngeal nerve innervate?
Cricothyroid (motor)
Inferior pharyngeal (motor)
What does the internal branch of the superior laryngeal nerve innervate?
Sensory to the laryngeal tissue above the vocal cords.
What VAA should be avoided in ear surgery?
N₂O
_____ ear surgeries (cocheal implant, endolympathic sac, or labrynth) often are prone to PONV.
Inner
What ear surgery requires controlled hypotension?
Mastoidectomy
To control bleeding.
No ____ in middle ear surgery.
N₂O
What is the Samter Triad?
- Nasal polyps
- Asthma
- Sensitivity to aspirin and NSAIDs (leading to severe bronchospasm)
Risk of postoperative bleeding in nasal and throat surgery necessitates the holding of what meds?
NSAIDs and aspirin
What dosage of cocaine is used for vasoconstriction in nasal surgeries?
4%
What is the maximum dosage of cocaine?
1.5 mg/kg
Oxymetazoline should be avoided in patients taking what drug class?
MAOI’s
Patients with nasal polyps, asthma, and sensitivity to asthmas are at increased risk for ________ during their procedure.
Bronchospasm
What are the anesthesia considerations for the presence of a goiter in thyroidectomy?
- Larynx deviation?
- Possible airway collapse at induction
- Horner syndrome
- SVC obstruction
What electrolyte imbalance is common secondary to hyperparathyroidism?
Hypercalcemia
What drugs may be required preoperatively for severe hypercalcemia?
- Fluids
- Lasix
- Bisphosphonates
What specialized ETT is used in parathyroidectomy and thyroidectomy?
Why?
NIMs ETT
- Used to identify the recurrent laryngeal and vagus nerves
Risk of false passage creation is more likely with a _____ trach.
Shiley
What drugs are avoided with free flap neck dissections?
Vasoconstrictors (PE, NE, etc.)
What are Le Fort fractures?
Midfacial fractures
What is a Le Fort I fracture?
Horizontal fracture involving inferior nasal opening.
Separates teeth and lower mandible from rest of skull.
What is a Le Fort II fracture?
What is a Le Fort III fracture?
- Fracture of nasal/orbital/zygomatic bones
- Separation of nasopharynx & base of skull
Very unstable
What are Le Fort osteotomies used for?
Correction of malocclusion of teeth by moving of the maxilla and/or mandible
What are the anesthesia considerations for a Le Fort osteotomy?
- Nasal intubation
- Deliberate hypotension
- Less fluids
- Awake extubation
- Jaws wired afterwards (No PONV)
Acute epiglottitis is associated with ______ ______.
H. Influenzae
What is Ludwig’s angina?
Floor of mouth infection
- Starts at mandibular molars and spreads to rest of mouth.
What occurs with the tongue in Ludwig’s angina?
Tongue is displaced posteriorly
Airway obstruction occurs in supine position.
What triad is required for an OR fire?
- Fuel (alcohol, gowns, drapes)
- Ignition (cautery)+
- Oxidizer (O₂ or N₂O)
