Respiratory Flashcards
What are the landmarks for trephination of the frontal, caudal and rostral maxillary sinuses?
Conchofrontal: 60% of the distance from the midline to the medial canthus and 0.5 cm caudal to the medial canthus Caudal maxillary: 2 cm rostral and 2 cm ventral to the medial canthus Rostral maxillary: 40% of the distance from the rostral end of the facial crest to the level of the medial canthus and 1 cm ventral to a line joining the infra- orbital foramen and the medial canthus
What is the reoccurrence rate of ethmoid hepatomas treated with surgical treatment?
43%
List the surgical options and success rates (according to Auer) for treatment of DDSP
Staphlectomy: 70% Standard myectomy: 58-71% Minimally invasive myectomy: 58-70% Laryngeal tie-forward 85-90%
List the surgical options for treatment of recurrent laryngeal hemiplegia
Prosthetic laryngoplasty Ventriculecomy (sacculectomy) Ventriculocordectomy Reiteration of CAD muscle Partial arytenoidectomy
Describe the procedure for a prosthetic laryngoplasty
General anaesthesia Lateral recumbency, head and neck extended Videoendoscope secured transnasally Aseptic prep and drape 10-12cm skin incision ventral and parallel to linguofacial vein, extending caudally from point 4cm cranial to rams of mandible Blunt and sharp dissection with Metzenblum scissors separates linguofacial from lateral margin of omohyoideus along length of incision Elevation of lingufacial vein with Allis tissue forceps allows cleavage plane between sternocephalicus and cricothyroideus - digitally open and enlarge Exposes dorsal aspect of larynx 6-8cm wide malleable retractor placed under linguofacial vein and sternocephalicus muscle used to expose larynx Muscular process of arytenoid under cranial portion of cricopharyngeus and this is exposed by sharply separating the cricopharynxgeus and thyropharyngeus muscles along junction of aponeuroses (alternatively, plane of dissection created off black edge of cricopharynxgeus under vascular plexus that lies over CAD Avoid oesophagus, thyroid gland, laryngeal and thyroid vessels and ventral branch of first cervical and cranial laryngeal nerves Suture materials: braided polyester, with (No. 5 Micron) or without silicone coating, 6mm surgical stainless steel wire, braided lycra, nylon Needle: large swaged on reverse cutting needle or No. 3 Martin uterine reverse-cutting needle Two suture placed Suture placed through cricoid cartilage - walk needle off caudal edge of cricoid 2-3mm lateral to dorsal midline. Needle advanced cranially while avoiding penetration into lumen of larynx. Needle penetrates cricoid 2-3cm cranial to caudal border and 1cm lateral to dorsal ridge Check laryngeal lumen on scope Second suture placed and held with haemostats Suture placed through muscular process.Used No. 6 Mayo needle or No. 6 Martin uterine needle (3mm bone trochar can be used to make tunnel, or 12-16Ga hypodermic needle can make tunnel) Optional to transect tendon of intention of CAD and open cricoarytenoideus articulation and curette joint space (PMMA can also be used) prior to placement of suture Place needle through muscular process from caudomedial to craniolateral direction or caudal to cranial direction Place tension on sutures to remove slack. Tie sutures and visualise larynx. Leave cut ends of suture 1.5-2cm long. Need to achieve 88% of cross sectional rims glottis area Thyropharyngeus and cricopharynxgeus muscles apposed with simple continuous 2-0 absorbable store Apposition of fascia adjacent to linguofacial vein to omohyoideus muscle with simple interrupted or continuous sutures of 2-0 absorbable suture Skin closed with staples or 2-0 non absorbable monofilament suture Stent bandage Can then perform ventriculcordectomy
Name the surgical approaches to the guttural pouch and the advantages and disadvantages of each
Hypovertebrotomy - Risk of injuring parotid gland and parotidoauricularis muscle
Viborg’s triangle - Close to parotid duct and vagus nerve
Whitehouse - Access to dorsal aspect and digital access to lateral aspect. Deep incision but on increase in complication rate
Modified Whitehouse - Access to dorsal aspect and digital access to lateral aspect. Deep incision but on increase in complication rate
Garm’s technique - Avoid important nerves but incision tight so can do little once in the GP
List the surgical options for treatment of guttural pouch mycosis
Ligation of common carotid artery and branches
Balloon catheter occlusion of internal carotid artery
Balloon catheter occlusion of external carotid artery and branches
Occlusion of internal carotid artery with detachable balloon catheter system
Tansarterial coil embolisation
Transarterial Nitinol Vascular Occlusion Plug Embolisation
List the differential diagnoses for bilateral epistaxis
■ Trauma (iatrogenic/external head trauma)
■ Guttural pouch mycosis
■ Progressive ethmoidal haematoma (unilateral or bilateral)
■ Exercise-induced pulmonary haemorrhage
■ Neoplasia (unilateral or bilateral)
■ Clotting/bleeding disorders
■ Pneumonia/pulmonary abscess
■ Rhinitis/sinusitis (unilateral or bilateral)
Unilateral:
Foreign body
Nasal amyloidosis/polyps (unilateral)
Infected nasolacrimal duct (unilateral)
. Name the surgical approaches to the guttural pouch and the advantages and disadvantages of each
Hypovertebrotomy - Risk of injuring parotid gland and parotidoauricularis muscle
Viborg’s triangle - Close to parotid duct and vagus nerve
Whitehouse - Access to dorsal aspect and digital access to lateral aspect. Deep incision but on increase in complication rate
Modified Whitehouse - Access to dorsal aspect and digital access to lateral aspect. Deep incision but on increase in complication rate
Garm’s technique - Avoid important nerves but incision tight so can do little once in the GP
List the surgical options for treatment of guttural pouch mycosis
Ligation of common carotid artery and branches
Balloon catheter occlusion of internal carotid artery
Balloon catheter occlusion of external carotid artery and branches
Occlusion of internal carotid artery with detachable balloon catheter system
Tansarterial coil embolisation
Transarterial Nitinol Vascular Occlusion Plug Embolisation
List the differential diagnoses for bilateral epistaxis
■ Trauma (iatrogenic/external head trauma)
■ Guttural pouch mycosis
■ Progressive ethmoidal haematoma (unilateral or bilateral)
■ Exercise-induced pulmonary haemorrhage
■ Neoplasia (unilateral or bilateral)
■ Clotting/bleeding disorders
■ Pneumonia/pulmonary abscess
■ Rhinitis/sinusitis (unilateral or bilateral)
Unilateral:
Foreign body
Nasal amyloidosis/polyps (unilateral)
Infected nasolacrimal duct (unilateral)
What are the landmarks for trephination of the frontal, caudal and rostral maxillary sinuses?
Conchofrontal: 60% of the distance from the midline to the medial canthus and 0.5 cm caudal to the medial canthus
Caudal maxillary: 2 cm rostral and 2 cm ventral to the medial canthus
Rostral maxillary: 40% of the distance from the rostral end of the facial crest to the level of the medial canthus and 1 cm ventral to a line joining the infra- orbital foramen and the medial canthus
What is the reoccurrence rate of ethmoid hepatomas treated with surgical treatment?
43%
