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ENT
Instrumentation in Otologic and Neurotologic Surgery
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
11 sections · 113 slides
Scope and Operative Constraints
- Operative constraints of the temporal bone
- Structure of this account
- Regions served by these instruments
Specula and Retractors
- Principles of exposure in otologic surgery
- Lempert speculum
- Aural speculum
- Aural speculum selection pearls
- Self-retaining retractors
- Retractor use in mastoid surgery
- House-Urban middle fossa retractor
Suction and Irrigation
- Roles of suction in otologic surgery
- Frazier and Baron suctions
- Microsuction and gauge sizing
- Suction-irrigator during mastoidectomy
Elevators
- Periosteal elevators
- Round knife and the tympanomeatal flap
- Gimmick (annulus) elevator
- Sequence of transcanal middle ear access
Pistol-Grip and Cochlear Implant Instruments
- Design principle of pistol-grip instruments
- Alligator forceps
- Cup forceps and Bellucci scissors
- Cochlear implant instruments
Curettes, Knives, Picks and Rasps
- Bone and cerumen curettes
- Microsurgical knives, picks and rasps
- Rosen needle
- I-S joint knife and oval window rasp
- Whirlybird and sickle knife
Telescopes and Mirrors
- Limitation of microscopic line of sight
- Rigid endoscope
Drills
- Otologic drill
- Bur selection
- Microdrills in the middle ear
Hemostatic Agents and Techniques
- Anatomic basis of hemostatic difficulty
- Consequences of bleeding in the operative field
- Principles governing agent selection
- Three categories of hemostatic technique
- Methods for hemostasis in otologic and neurotologic surgery
- Methods for hemostasis in otologic and neurotologic surgery (continued)
- Methods for hemostasis in otologic and neurotologic surgery
- Methods for hemostasis in otologic and neurotologic surgery (continued)
- Methods for hemostasis in otologic and neurotologic surgery
- Methods for hemostasis in otologic and neurotologic surgery (continued)
- Methods for hemostasis in otologic and neurotologic surgery
- Methods for hemostasis in otologic and neurotologic surgery (continued)
- Systemic hemostatic techniques
- Evidence for total intravenous anaesthesia
- Surgical hypotension in otologic surgery
- Preoperative embolisation of vascular tumours
- Local injection of vasoconstrictor
- Role of powered hemostatic instruments
- Applications of bipolar cautery
- Lasers as hemostatic instruments
- Hemostasis with a diamond bur
- Powered devices without otologic application
- Classification of topical hemostatic agents
- Combination and sequential use
- Nonimplantable agents
- Surgical gauze and pledgets
- Disadvantages of surgical gauze
- Bone wax
- Bone wax application technique
- Ligature and aneurysm clips
- Passive resorbable agents: principles
- Cautions with passive resorbable agents
- Oxidised cellulose
- Gelatin and collagen agents
- Synthetic bone wax substitute
- Active agents: epinephrine and thrombin
- Fibrinogen and thrombin sealants
- Practical limits of fibrin sealant delivery
- Evidence for fibrin sealant
- Combination agents
- Gelatin-thrombin matrix
- Evidence for gelatin-thrombin matrix
- Sealants, adhesives and glues: terminology
- Conclusions on hemostasis
Lasers
- Advantages of laser surgery in the ear
- Reported laser applications beyond the middle ear
- Defining properties of laser light
- Quantised energy levels and photon absorption
- Conversion of photon energy to tissue effect
- Wavelength selection and target tissue
- Design requirements for otosclerosis lasers
- Laser interaction with bone and collagen
- Absorption in water: argon and KTP versus carbon dioxide
- Three lasers used in otologic surgery
- Predominant uses of otologic lasers
- Lasers in transcanal endoscopic ear surgery
- Argon laser
- KTP laser
- Carbon dioxide laser and beam delivery
- Flexible fibre carbon dioxide delivery
Summary
- Key points on instrumentation
- Key points on hemostasis and lasers
- References
- References
- References
- References
- References
- References
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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