II Lecture Chapter 17 Short Answer: Nasal Surgery pp 381

Why are the conchae (turbinates) removed? Which set is most commonly transected?

Hypertrophied turbinates may occur as a result of chronic rhinitis; the inferior turbinates are most often removed.

If a Caldwell-Luc is necessary due to tumors or problems with access from the nasal cavity, where is the incision made? When the incision is made, why is great care required?

The gingiva above the canine tooth and second molar (sulcus incision) is incised as the periosteum of the inferior wall of the maxilla is elevated. Carefully identify and retract the infraorbital nerve

why do you think bayonet-style forceps would be used for a deep hole such as a nostril?

bayonet or takahashi forceps will be needed to excise tissue remnants They are thin and long, allowing them to reach through a deep hole without puncturing structures.

Define choanal atresia.

A congenital defect caused by the failure of the nasopharyngeal septum to rupture during embryonic development. The result is the bony or membranous occlusion of the passageway between the nose and the pharynx.

Why is the wound classification a clean-contaminated (II) case?

Clean-contaminated — an incision through which the respiratory, alimentary or genitourinary tract is entered under controlled conditions but with no contamination encountered. The nose is a place of controlled entry into the aerodigestive tract

Name the four paranasal sinuses. These sinuses have openings that can become infected when the mucous membranes swell with chronic inflammations and close off the area, creating a mucocele. What are the openings called?

Frontal sinuses: behind the eyebrows Ethmoid sinuses: between the eyes Sphenoid sinuses: behind the nose Maxillary sinuses: below the eyes

What are the more common methods of removal of the turbinates?

Inferior Turbinectomy Microdebrider Turbinectomy Laser Turbinectomy

What causes the nasal septum to deviate from the midline?

aging trauma

If the case is posted as a septorhinoplasty, what procedures would be done during this case?

septoplasty rhinoplasty mentoplasty

Polyps can occur anywhere there is a mucous membrane along the GI tract and in the sinuses. What is frequently used to remove a polyp?

treatment with steroids surgical removal with polyp snare

There are dangers regarding sinus surgery due to the proximity for the sinus cavity to the orbits. What should the surgical team be looking for on the monitor?

If the orbit is accidentally entered, it can be confirmed by the presence of the yellow orbital fat on the monitor. If any member of the surgical team views this on the monitor, the surgeon should be immediately told.

What will be included in the postoperative dressings for a septoplasty?

Internal and external splints with a "mustache" dressing metal or fiberglass splint

Identify the difference between the two main techniques used to repair a choanal atresia.

Transseptal Technique: This technique consists of making an incision in the septum in order to visualize the bony and/or membranous obstruction; a microscope is used by the surgeon. The obstruction is then removed by powered burrs or microdebrider. Endoscopic Technique: The 4-mm endoscope is inserted endonasally with its angle directed inferiorly. The surgeon will use powered burrs and/or a microdebrider to repair the choanal atresia.

Prior to the case, a separate small setup may be used to prepare the site and provide analgesia and hemostasis. What is used for the setup?

a prep stand (extra Mayo) nasal speculum bayonet forceps local anesthetic with epinephrine 10-mL Luer-Lok syringe with 25-gauge needles cocaine and/or oxymetazoline cottonoids

Sometimes the enlargement of the ostia is necessary; what would be used during a functional endoscopic sinus surgery (FESS)?

basic nasal set endoscopic instruments endoscopic video equipment camera sinuscope light cord 4- or 5- mm sinuscopes 0- ,30- ,70- ,90- , and 120- degree lenses antifog suction-irrigation navigational system An antrum punch, spoon, or probe will be used. An antrum trocar or rasp is used to make an intranasal window.