Date post: | 13-Apr-2017 |
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Healthcare |
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RECENT TRENDSRECENT TRENDS IN IN
OTORHINOLARYNGOLOGY OTORHINOLARYNGOLOGYBy
Dr. Vijayasundaram ASSO PROF .
MGMCRI
INTRODUCTIONINTRODUCTION
Diversity of subspecialitiesMultidisciplinary approachComputer guided surgeryAdvanced microsurgical techniques
Digital Hearing AidsDigital Hearing Aids
Multiprogram device with self adaptationSignals processed to suppress noiseAmplify specific frequenciesProvides clear hearingEnhanced sound qualityGreatly reduced feedback & easy handling
BAHABAHA
Direct bone conductionDirect vibration transmission pathThree modes of excitationParts of BAHAIndicationsContraindications
Auditory Brainstem ImplantAuditory Brainstem Implant
Electrical stimulation of 2nd auditory neuronNeurofibromatosis type 2 & traumatic cases21 channel electrodes placed in brainstemBody level speech processorTransmission coil on the scalpImproves conversational ability
Cochlear ImplantCochlear Implant
Latest C-II bionic ear implant90,000 updates/secStimulation rates of 91,000 pulses/secIn profoundly deaf patientsSingle & multichannel More speech understanding
BiomaterialsBiomaterials
Silicone rubber (silastic)TeflonTORP & PORP Future implants-Biomimetics
Meniere’s diseaseMeniere’s disease
• Endolymphatic sac decompression• Modification( of Portmann’s technique)• Transcanal gentamycin instillation• Selective vestibular neurectomy
Virtual reality simulatorVirtual reality simulator
• Special helmet and glove for viewing• 3-D world view• Virtual patient- data set of CT & MRI• Virtual Otoscopy- Display of 3 diff. views• Endoscopic sinus simulator
Facial Cosmetic SurgeryFacial Cosmetic Surgery
• Grafts• Tissue advancement techniques• Surgical decompression of facial nerve • Surgical rehabilitation of facial n.palsy• Non-specific techniques for neuromuscular
retraining
Skull Base SurgeriesSkull Base Surgeries
• Fisch Infratemporal fossa approach• Posterior approach• Lateral approach• Combined
Gallium ScanGallium Scan
• In Malignant Otitis externa• Stage I, II, III• Anti-pseudomonal antibiotics• Treatment duration depending on scan
Approaches to CFRApproaches to CFR• Anterosup sinonasal Area – Lat Rhinotomy• Anterosup sinonasl area & Frontal sinus – Lat Rhinotomy
with Lymel Extension• Supr Sinonasal Area – Mid Facial Degloving • Angiofibroma with intracranial extension through
cribriform plate –Transcervical Transmandibular Transpalatal
• Benign Tumours Involving Cribriform plate with minimal exrension to orbit-Medial Maaxillectomy with microscope
Eagle’s syndromeEagle’s syndrome
• Symptoms• Diagnosis by Digital Palpation, Intra-
anaesthetic solution injected.• Investigation –OPG, AP and Lat skull films• Treatment- Intra-oral & extra-oral approach
External approaches External approaches Anterior Cricoid Split Laryngofissure with Posterior Cricoid Split Laryngotracheoplasty Myo-hyoid flap with temporary stent Sternomastoid-clavicular periosteal flap Laryngeal Reconstruction by Augmentation Resection of Cricoid with Thyro-Tracheal anastmosis Resection with end to end anastomosis (Grillo)
StentsStents• Types : Finger Cots• Endotracheal Tubes• Montgomery T-Tubes• Artificial Support that maintains airway
patency• Sialastic Sheet Rolls• Aboulker Stent• Cotton – Lorenz Stent• Acrylic Stent
Phonosurgical techniquesPhonosurgical techniques
Vocal cord medialisation• - Injection: Teflon, fat,collagen• - Thyroplasty• - Arytenoid adduction• - Reinnervation
Contd..Contd..
Lateralization procedure• Laser aryteniodectomy/cordotomy• Cordopexy with/without arytenoid
removal• Woodman's operation• Reinnervation• Endoscopic Augmentation Technique
Neck DissectionsNeck Dissections
• Radical Neck dissection• Modified Neck Dissection-Type I, II, III• Selective Neck Dissection Supraomohyoid neck dissection- Clearance of level I, II ,III ,IV
Lateral neck dissection-II, III ,IV & VI
- Central compartment dissection
LaryngectomyLaryngectomy
Wide field laryngectomyConservation surgerySupraglottic laryngectomySupracricoid laryngectomyVertical hemilaryngectomyNear Total and Total Laryngectomy
Provox 2 voice prosthesisProvox 2 voice prosthesis
• Latest voice rehabilitation prosthesis• Low resistance indwelling medical grade
silicone device• Prosthesis insertion tool & cleaning brush• Inserted through tracheostoma or mouth
Flaps in Head & Neck Flaps in Head & Neck ReconstructionReconstruction
• Local flaps - Random - Axial pattern• Distant axial - Deltopectoral - Cervical - Occipitomastoid• Myocutaneous • Free - Free Jejunal flap