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Specific Issues for Revision fess Surgery

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1. Observe available landmarks both radiographically and

clinically.

2. Moving first from anterior to posterior, check each sinus

for abnormality. 3. Define or create landmarks necessary to operate safely

on a sinus-by-sinus basis as the surgeon moves

posteriorly.

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4. The two most important landmarks are the followinga)

the maxillary antrostomy to define the lamina papyracea

and sphenoid sinus. b)The sphenoid sinus to define the

skull base 5. Repair abnormalities of the maxillary, lower ethmoid and

sphenoid sinus first.

6. Once skull base landmarks are defined, repair the upper

ethmoid and frontal sinuses in a posterior-to anterior

direction, ending with the frontal sinus.

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7. The same safety techniques for primary ESS apply for

revision ESS.

8. There is no easy revision surgery.

9. Revision surgery is a situation where part of or the wholemiddle turbinate may need removal.

10. Stenting may be necessary.

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Classification of Complications

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The category correctable with treatment consists of

orbital hematoma (postseptal), loss of vision, diplopia,

CSF leakage, meningitis, brain abscess, focal brain

hemorrhage, hemorrhage requiring transfusion,carotidartery injury, and epiphora.

Permanent major complications are blindness, diplopia,

central nervous system deficit, and death.

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What is atticotomy?

Limited portion of the external canal wall is

sacrificed

Small attic sac cholesteatoma exteriorized by

drilling the scutum to the limits of the sac.Defect is reconstructed with bones or cartilage

graft

For limited attic cholesteatoma confined tocentral epitympanum

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Identify the instrument

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COBLATOR

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WHAT IS COBLATION

Coblation is a unique method of rapid and

controlled removal of tissue at relatively low

temperatures (typically 40-70C) while

maintaining the integrity of surrounding tissue orstructures.

"Coblation" is a synthetic term that means "cold

"and "removal".

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Using radio frequency in a bipolar mode with a

conductive solution, such as saline, Coblation

energizes the ions in the saline to form a small

plasma field.

The plasma has enough energy to break the

tissue's molecular bonds, creating an ablative

path.

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The plasma's energized particles have sufficient

energy to break molecular bond within tissue,

causing tissue to dissolve at relatively low

temperatures (typically 40C to 70C).

The result is volumetric removal of target tissue

with minimal damage surrounding tissue.

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IDENTIFY THE INSTRUMENT

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IDENTIFY THE INSTRUMENT

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KOENIG TRACHEOSTOMY TUBE

Used in difficult airway

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IDENTIFY THE INSTRUMENT

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KERRISON S PUNCH

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Identify the instrument

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Trousseau tracheal dilator

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Identify the instrument

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Turbinectomy scissors

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Identify the instrument

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Asch forceps