Chapter 185 - Septoplasty, Turbinate surgery Flashcards
(42 cards)
Strut - what it is, why its important
1.cm dorsocaudal
Avoid loss of tip support, saddle nose
What to do with excised cartilage
May replace into mucoperichondrial pocket to decrease septal perf risk
Blood supply to IT
br of posterior lateral nasal artery
Tip support maj/min
Major: septum, lower lateral cart, upper lat (attachments between these)
Minor: interdomal lig, dorsal septum, membranous septum, sesamoid, skin, SQ tissue of tip, maxillary spine
Nose in cleft lip/palate
I/L LLC displaced I/P/L
Nasal tip, caudal septum, columella toward non-cleft side
Bony septum toward cleft side
Common complications of untreated septal hematoma
Septal perf, Saddle nose
What to do if afrin is injected into vessels
phentolamine (a blocker)
Oxymetazoline will cause HTN, vasoconstriction, tachycardia
Sx of TSS
high fever, vomiting, hypotension, diarrhea, rash, multiorgan failure
Due to TSST-1 toxin
How many people have a deviated septum?
50%
most asymptomatic
Killian vs Hemitransfixion vs Transfixion
Killian - past mucocutaneous junction, less risk of tip support loss?
Hemi- at mucocutaneous junction, better access to caudal septum, allows bilateral flap elevation
Transfixion - bilateral hemi, allows access to caudal, columella, medial crura
Steps to septoplasty
- afrin spray, inject epi:lido bilateral in subperichondrial space
- incision near caudal septum, subperichondrial flap
- disarticulate septal cart, remove bony septum if necessary
- resect septal cart (leave strut)
- repair tears in flaps
- consider replacing excised septum into mucoperichond pocket
- close mucosal incision, quilt septum, splints
Postop care and instructions after septoplasty
May have congestion, pain, bloody drainage mild intermitt, fatigue. Also may have nausea, dry mouth, difficulty sleeping
ABX, analgesics, antiemetics
Moisten nasal cavities with saline, keep head elevated
Take a week off work/school
Light activity first week
Full activity 1-2 weeks
F/u in 1-2 weeks
Complete mucosal healing within 3-4 weeks
Risks of septoturbinoplasty
infection, bleed, dry/crust, persist congestion, hematoma/abscess, perf, scar, alter smell/taste, numb, CSF leak, cosmesis
Anatomy of IT
medial submucosal tissue - vein, erectile
lateral- glandular
Hasner’s valve (flap at NLD orifice) opens into inf meatus
Max dose of lidocaine, bupivacaine, cocaine
Lido: 5 (without epi) 7 (with epi) mg/kg (some say 4/7.5)
Bupiv: 3mg/kg
Cocaine: 2-3 mg/kg or 200mg
Amides vs Esters
Amide- metaolized in liver. Lidocaine, Bupivacaine. Almost never have allergic rxn (if so, likely to preservative)
Ester- met in liver and plasma, may have allergic rxn, ut still likely due to preservative. Cocaine.
Sx of local anesthetic toxicity
- Sense of doom, HA, anxiety, palp, respiratory distress, HTN, restless, disorient, rambling speech, seizures, vomiting, tachy, sweat
- THEN: LOC, apnea, bradycardia, hypotension, CV collapse
prilocaine, banzocaine toxicities, how to treat the major one
Benzo 200mg, Prilo 7mg/kg
Methemoglobinemia - hypoxia, SOB, cyanosis, AMS, HA
arrythmia, seizure, coma, death
Pulse ox inaccurate
Tx- supp O2, slow IV influsion of 1-2 mg/kg 1% methylene blue
Improving hemostasis in nasal surgery
Stop anti-coagulant meds 1-2 weeks before and after surgery
HOB elevated 30 deg during surg
Decongestants
Minimize mucosal trauma
When congestion due to turbinate hypertrophy is better during the day
upright
exposure to steam
exercise
When to do surgery on turbintes
Persistent sx affecting QOL
Despite steroids, a-histamine, saline, decong
Treatment of ozena
(Empty Nose Syndrome)
Saline, topical ointments, augment inferolateral nasal wall
When to consider middle turbinate surgery
Avoid if unnecessary because it helps with humidification, airflow, proper sinus drainage, olfaction
May reduce if polypoid degeneration or concha bullosa
Internal nasal valve
Septum, head of inf turb, upper lateral cartilage
