Ophthalmic and Otorhinolaryngologic Surgery Flashcards
Define Cataract extraction ECCE
extracapsular cataract extraction
Removal of opaque ocular lens and replacing it with an IOL implant
Anterior capsule, cortex and nucleus removed with posterior capsule left in place
Anatomy and physiology Cataract extraction ECCE
Conjunctiva Cornea Sclera Limbus Anterior chamber of the globe Lens plus parts: nucleus, cortex, capsule (learn all 3 parts) Iris Physiology: Vision; refraction (focus)
Pathology/indication Cataract extraction ECCE
Opaque ocular lens
Procedure steps summary Cataract extraction ECCE
Apply local (topical gtts); place lid speculum
Incisions: Limbal flap and 2ndport; inject Healon
Perform capsulotomy (capsulorrhexis forceps)
Loosen nucleus (hydrodissect or cyclodialysis spatula)
Emulsify nucleus with phacoemulsification machine
Remove cortex by irrigating and aspirating (I&A)
Place implant; I&A Healon
Administer topical medications, dress PRN
Define Tympanoplasty
Surgical repair of the tympanic membrane (eardrum)
Anatomy and physiology Tympanoplasty
External ear: Pinna External auditory canal Tympanic membrane Middle ear: Malleus Incus Stapes Temporalis fascia (for graft) Physiology: hearing
Pathology/indication Tympanoplasty
Perforated tympanic membrane
Cholesteatoma (noncancerous skin growth that develops in the middle ear)
Ossicular discontinuity
Procedure steps summary Tympanoplasty
Inject local, place speculum, make incision
Harvest and prepare temporalis fascia for graft
FYI: Periosteal elevator; scissors/adsons; close
FYI: Place graft on silastic block; thin it out; dry out
Prepare ear drum for graft
Explore middle ear cavity; treat ossicles PRN
Trim and place graft; pack edges of graft with gelfoam
Pack canal; close, apply dressings
Define Sinus endoscopy (FESS)
Functional endoscopic sinus surgery
Visual exam of sinus cavities using minimally invasive technique.
Anatomy and Physiology Sinus endoscopy (FESS)
Nose Paranasal sinuses and ostia Maxillary Ethmoid Sphenoid Frontal Physiology: Unclear; may have to do with moistening and warming air
Pathology/Indication Sinus endoscopy (FESS)
Treat Chronic sinusitis Remove Polyps (allergies)
Procedure steps summary Sinus endoscopy (FESS)
Apply local agent; insert endoscope into nose Enlarge ostia FYI: aka maxillary antrostomy Remove diseased tissue FYI: Debrider; Blakesley forceps Ethmoidectomy and/or sphenoidotomy PRN Hemostasis, nasal packing, dress
Define Breast Reconstruction (TRAM)
Reconstruction of breast tissue using a transverse rectus abdominis myocutaneous pedicle flap graft
TRAM = transverse rectus abdominis myocutaneous
Anatomy and Physiology Breast Reconstruction (TRAM)
Lower abdominal wall
Skin, subcutaneous tissue
Rectus abdominis muscle
Physiology: body wall support
Pathology/Indication Breast Reconstruction (TRAM)
Post-mastectomy reconstruction
Procedure steps summary Breast Reconstruction (TRAM)
Incisions made for mastectomy scar and abdomen
Lower abdominal transverse elliptical incision is made
Tunnel subcutaneously up to breast area
Dissect flap with muscle attachment
FYI: divide rectus abdominis at its inferior attachment
Swing tissue into place, trim PRN, and secure
Close both areas; dress
4x4’s, ABD, tape (abdomen)
Non-adherent dressing; 4x4’s, supportive cover
Define Blepharoplasty
Surgical repair; eyelid/s
Anatomy and physiology Blepharoplasty
Eyelids
Pathology/Indication Blepharoplasty
Dermatochalasis obstructing visual field
Aesthetic purposes
Define Entropion/ectropion repair
Repair of:
Entropion: turning inward of eyelid; inverted lower eyelid margin
Ectropion: turning outward of eyelid; eversion of lower lid
Anatomy and physiology Entropion/ectropion repair
Eyelids
Pathology/Indication Entropion/ectropion repair
Entropion: turning inward of eyelid; inverted lower eyelid margin
Ectropion: turning outward of eyelid; eversion of lower lid
Define Enucleation
Removal of entire ocular globe with insertion of implant
Anatomy and physiology Enucleation
entire globe
extraocular muscles (3 pairs) of the eye:
Superior oblique & Inferior oblique
Superior rectus & Inferior rectus
Lateral rectus & Medial rectus
Pathology/Indication Enucleation
Intraocular tumors; trauma; infection (intractable)
Define Vitrectomy w/scleral buckle
Removal of all or part of vitreous body with placement of device to press sclera toward retina with internal access via the pars plana
Anatomy and physiology Vitrectomy w/scleral buckle
globe and layers, vitreous, retina, pars plana
Pathology/Indication Vitrectomy w/scleral buckle
Retinal detachment
Define Iridectomy
Excision of (part of) iris
Anatomy and physiology Iridectomy
anterior ocular cavity - choroid layer, ciliary body, iris, trabecular meshwork
Pathology/Indication Iridectomy
Angle-closure glaucoma (acute, sub-acute, or chronic)
Define Dacryocystorhinostomy
Making a new opening between the tear sac and the nose
Anatomy and physiology Dacryocystorhinostomy
lacrimal duct system
Pathology/Indication Dacryocystorhinostomy
Resistant obstruction of the nasolacrimal duct
Define Stapedectomy
Removal of entire stapes with oval window graft and replacement with a prosthesis
Anatomy and physiology Stapedectomy
External ear: Pinna External auditory canal Tympanic membrane Middle ear: Malleus Incus Stapes Temporalis fascia (for graft) Physiology: hearing
Pathology/Indication Stapedectomy
Otosclerosis (hardened bone) causing conductive hearing loss
Define Cochlear implant
Insertion of a device to stimulate the cochlea
Anatomy and Physiology Cochlear implant
External ear: Pinna External auditory canal Tympanic membrane Middle ear: Malleus Incus Stapes Temporalis fascia (for graft) cochlea, temporal bone and mastoid process Physiology: hearing
Pathology/Indication Cochlear implant
Profound hearing loss; sensorineural