ENT AND HEAD AND NECK PROCEDURES An operative guide George Mochloulis, MD, CCST (ORL-HNS) Consultant ENT and Head and Neck Surgeon Lister Hospital, Stevenage, Hertfordshire, UK F. Kay Seymour, MA (Cantab), FRCS (ORL-HNS) Consultant ENT Surgeon St Bartholomew's and the Royal London Hospitals, London, UK Joanna Stephens, MBChB, FRCS (ORL-HNS) ENT SpR Royal National Throat Nose & Ear Hospital, London, UK Ch.00aPrelims vFi.indd 1 11/12/13 9:03 PM CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2014 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20140107 International Standard Book Number-13: 978-1-4822-4698-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface 5 Consent table 6 1 Grommet insertion 11 2 Removal of lesion from pinna – wedge excision 12 3 Excision of preauricular sinus 13 4 Myringoplasty 14 5 Ossiculoplasty 18 6 Stapedotomy 20 7 Mastoidectomy and canalplasty 22 8 Cochlear implantation 27 9 Manipulation under anaesthesia of fractured nose 30 10 Septoplasty 31 11 Surgery to inferior turbinates 34 12 Endoscopic sphenopalatine artery ligation 36 13 Anterior ethmoidal artery ligation 37 14 Functional endoscopic sinus surgery (FESS) 39 15 Septorhinoplasty 42 16 Lateral rhinotomy and medial maxillectomy 46 17 Maxillectomy 49 18 Endoscopic dacryocystorhinostomy 51 19 External carotid artery ligation 52 20 Midfacial degloving 54 21 Fine needle aspiration cytology 56 22 Lymph node biopsy 57 23 Tonsillectomy and adenoidectomy 59 Ch.00aPrelims vFi.indd 3 11/12/13 9:03 PM Contents 24 Uvulopalatoplasty 62 25 Tracheostomy 64 26 Diagnostic procedures in the upper aerodigestive tract 68 27 Paediatric microlaryngoscopy and bronchoscopy (MLB) foreign body removal 74 28 Phonosurgery 77 29 Microlaryngoscopy and laser use 80 30 Pharyngeal pouch 82 31 Submandibular gland excision 85 32 Superficial parotidectomy 87 33 Thyroglossal cyst excision 90 34 Thyroidectomy 92 35 Neck dissection 96 36 Total laryngectomy 101 37 Pectoralis major myocutaneous flap 105 38 Local flaps 107 39 Pinnaplasty 112 40 Blepharoplasty 115 41 Face lift 118 Index 123 44 Ch.00aPrelims vFi.indd 4 11/12/13 9:03 PM Preface There are a number of excellent operative Similarly, while we have included an easy textbooks available, which provide detailed reference table of complications that should specialist and subspecialist knowledge. be discussed with the patient when obtaining However, we feel there is a need for a clear, consent, we have not included a discussion on concise, step-by-step operative guide, to the surgical anatomy, indications, or benefits. which the junior trainee can refer for an We are extremely grateful to our coauthors, overview of core Otolaryngology, Head and and would like to thank them for their help and Neck, and Facial Plastics procedures. This book contributions, as outlined below. In addition, hopes to provide comprehensive information special thanks go to Nikos Papadimitriou for to allow the trainees to perform the operations his help in the early stages of writing, and to themselves under appropriate supervision, Alasdair Mace for his invaluable help with and is designed to be small enough to carry reviewing this book. with you day to day. As a team of authors, we have drawn on Contributors our experience, both at trainee and consultant 5 – Mr. S. Ahluwalia level, and from colleagues within the specialty 5 – Prof. A. Narula to put together a practical guide of how to 6 – Mr. C. Giddings make an operation succeed. Although different 14 – Mr. A. Frosh surgical approaches can provide equally good 15, 16 – Mr. C. Georgalas outcomes, this is beyond the scope of this 23, 24 – Mr. K. Ghufoor textbook. We have simply described tried and 34 – Mr. N. Tolley tested techniques, which we find work. 5 Ch.00aPrelims vFi.indd 5 11/12/13 9:03 PM Consent Table Otology Bleeding Infection Chronic Residual Scar Alteration Dizziness Reduced Tinnitus Dead Facial nerve Further otorrhoea perforation in taste hearing ear injury surgery Chapter 1 Grommet insertion √ √ √ √ 2 Excision lesion pinna √ √ √ √ 3 Excision preauricular sinus √ √ √ √ 4 Myringoplasty √ √ √ √ √ √ √ √ √ 5 Ossiculoplasty √ √ √ √ √ √ √ √ √ 6 Stapedotomy √ √ √ √ √ √ √ √ √ √ 7 Mastoidectomy √ √ √ √ √ √ √ √ √ √ √ Rhinology Bleeding Infection Septal Scar Nasal CSF Visual Further Nasal POP perforation obstruction leak disturbance surgery packs 9 MUA of fractured nose √ √ √ √ √ 10 Septoplasty √ √ √ √ √ 11 Surgery to inferior √ √ √ turbinates Surgical management of epistaxis: 12 SPA ligation +/- septoplasty √ √ √ √ √ √ √ 13 Anterior ethmoid artery √ √ √ √ √ ligation 14 Endoscopic sinus surgery √ √ √ √ √ √ √ +/- septoplasty 15 Septorhinoplasty √ √ √ √ √ √ √ √ 16 Lateral rhinotomy and medial √ √ √ √ √ √ √ √ √ maxillectomy 17 Maxillectomy √ √ √ √ √ √ 18 DCR +/- septoplasty √ √ √ √ √ √ Head and Neck Bleeding Infection Scar Tracheostomy Nerve Dental Nasal Pain Perforation Recurrence Further Drain injury trauma regurgitation surgery 21 FNAC √ √ 22 Lymph node biopsy √ √ √ XI; marginal √ mandibular 23 Tonsillectomy and √ √ √ √ √ a denoidectomy 24 Uvulopalatoplasty √ √ √ √ √ √ 25 Tracheostomy √ √ √ √ 66 Ch.00bConsent vFi.indd 6 11/12/13 9:03 PM Otology Bleeding Infection Chronic Residual Scar Alteration Dizziness Reduced Tinnitus Dead Facial nerve Further otorrhoea perforation in taste hearing ear injury surgery Chapter 1 Grommet insertion √ √ √ √ 2 Excision lesion pinna √ √ √ √ 3 Excision preauricular sinus √ √ √ √ 4 Myringoplasty √ √ √ √ √ √ √ √ √ 5 Ossiculoplasty √ √ √ √ √ √ √ √ √ 6 Stapedotomy √ √ √ √ √ √ √ √ √ √ 7 Mastoidectomy √ √ √ √ √ √ √ √ √ √ √ Rhinology Bleeding Infection Septal Scar Nasal CSF Visual Further Nasal POP perforation obstruction leak disturbance surgery packs 9 MUA of fractured nose √ √ √ √ √ 10 Septoplasty √ √ √ √ √ 11 Surgery to inferior √ √ √ turbinates Surgical management of epistaxis: 12 SPA ligation +/- septoplasty √ √ √ √ √ √ √ 13 Anterior ethmoid artery √ √ √ √ √ ligation 14 Endoscopic sinus surgery √ √ √ √ √ √ √ +/- septoplasty 15 Septorhinoplasty √ √ √ √ √ √ √ √ 16 Lateral rhinotomy and medial √ √ √ √ √ √ √ √ √ maxillectomy 17 Maxillectomy √ √ √ √ √ √ 18 DCR +/- septoplasty √ √ √ √ √ √ Head and Neck Bleeding Infection Scar Tracheostomy Nerve Dental Nasal Pain Perforation Recurrence Further Drain injury trauma regurgitation surgery 21 FNAC √ √ 22 Lymph node biopsy √ √ √ XI; marginal √ mandibular 23 Tonsillectomy and √ √ √ √ √ a denoidectomy 24 Uvulopalatoplasty √ √ √ √ √ √ 25 Tracheostomy √ √ √ √ (Continued) 7 Ch.00bConsent vFi.indd 7 11/12/13 9:03 PM Head and Neck Bleeding Infection Scar Tracheostomy Nerve Dental Nasal Pain Perforation Recurrence Further Drain injury trauma regurgitation surgery Chapter 26 Endoscopy – d iagnostic √ √ √ √ √ √ procedures of upper aerodigestive tract 27 Paediatric MLB and √ √ √ √ √ bronchoscopy 28 Phonosurgery √ √ √ √ √ 29 Microlaryngoscopy √ √ √ √ √ 30 Pharyngeal pouch √ √ √ recurrent √ √ √ √ √ √ repair – endoscopic and laryngeal open approach 31 Submandibular gland √ √ √ marginal √ √ e xcision mandibular, XII 32 Parotidectomy √ √ √ VII + sensory of √ √ great auricuar nerve 33 Thyroglossal cyst excision √ √ √ √ √ √ 34 Thyroidectomy √ √ √ recurrent √ √ laryngeal & EBSLN 35 Neck dissection √ √ √ XI, XII, m arginal √ √ mandibular 36 Total laryngectomy + TEP √ √ √ √ XI, XII, m arginal √ leak √ mandibular Facial Plastics Bleeding Infection Scar Necrosis of Unsatisfactory Incomplete Nerve Dry Ectropion/ Visual Alopecia skin/flap cosmetic excision injury eyes entropion disturbance result 38 Local flaps √ √ √ √ √ √ temporal, marginal mandibular 39 Pinnaplasty √ √ √ √ √ 40 Blepharoplasty √ √ √ √ √ √ √ 41 Face lift √ √ √ √ motor √ branches of facial, sensory Note Scar - may be normal/hypertrophic/keloid MUA: manipulation under anaesthesia CSF: cerebrospinal fluid SPA: sphenopalatine artery DCR: dacryocystorhinostomy POP: plaster-of-Paris EBSLN: external branch of superior laryngeal nerve TEP: tracheoesophageal puncture FNAC: fine needle aspiration cytology MLB: microlaryngoscopy and bronchoscopy 8 Ch.00bConsent vFi.indd 8 11/12/13 9:03 PM Head and Neck Bleeding Infection Scar Tracheostomy Nerve Dental Nasal Pain Perforation Recurrence Further Drain injury trauma regurgitation surgery Chapter 26 Endoscopy – d iagnostic √ √ √ √ √ √ procedures of upper aerodigestive tract 27 Paediatric MLB and √ √ √ √ √ bronchoscopy 28 Phonosurgery √ √ √ √ √ 29 Microlaryngoscopy √ √ √ √ √ 30 Pharyngeal pouch √ √ √ recurrent √ √ √ √ √ √ repair – endoscopic and laryngeal open approach 31 Submandibular gland √ √ √ marginal √ √ e xcision mandibular, XII 32 Parotidectomy √ √ √ VII + sensory of √ √ great auricuar nerve 33 Thyroglossal cyst excision √ √ √ √ √ √ 34 Thyroidectomy √ √ √ recurrent √ √ laryngeal & EBSLN 35 Neck dissection √ √ √ XI, XII, m arginal √ √ mandibular 36 Total laryngectomy + TEP √ √ √ √ XI, XII, m arginal √ leak √ mandibular Facial Plastics Bleeding Infection Scar Necrosis of Unsatisfactory Incomplete Nerve Dry Ectropion/ Visual Alopecia skin/flap cosmetic excision injury eyes entropion disturbance result 38 Local flaps √ √ √ √ √ √ temporal, marginal mandibular 39 Pinnaplasty √ √ √ √ √ 40 Blepharoplasty √ √ √ √ √ √ √ 41 Face lift √ √ √ √ motor √ branches of facial, sensory Note Scar - may be normal/hypertrophic/keloid MUA: manipulation under anaesthesia CSF: cerebrospinal fluid SPA: sphenopalatine artery DCR: dacryocystorhinostomy POP: plaster-of-Paris EBSLN: external branch of superior laryngeal nerve TEP: tracheoesophageal puncture FNAC: fine needle aspiration cytology MLB: microlaryngoscopy and bronchoscopy 9 Ch.00bConsent vFi.indd 9 11/12/13 9:03 PM