Nasal Procedues
The nose is a facial feature that serves as the organ for the sense
of smell and as the upper portion of the respiratory system. Paired
nasolacrimal ducts enter the nasal cavity near the inferior meatus and
are part of the tear drainage system
Nasal Procedures
Diagnostic Procedures/Tests
Diagnostic approaches to nasal and paranasal sinus pathology include
direct vision, mirror examination, and radiographs.
Nasal Procedures
Direct Vision
The most common and highly effective method of examining the interior
of the nose is direct vision. This is accomplished with the use of a
lamp affixed to the examiners head.
Nasal Procedures
Mirror Examination
Another approach is mirrors examination of the nasopharynx and
posterior nasal cavity. The patient is instructed to open the mouth
and the tongue is gently retracted. A small mirror is warmed or
treated with a commercial antifog solution to prevent fogging,
inserted into the oropharynx and directed upward.The examiner should
be able to examine the posterior nares, the turbinates, the posterior
end of the vomer bone and the outlet of the maxillary sinus.
Nasal Procedures
Radidography
4 basic views make up a "sinus series". The Waters view,
Caldwell view, lateral view, and submental
Angiography is used to demonstrate blood flow. This can be useful in
determining the exact location of hemorrhage in case of traumatic
injuries or epistaxis
Nasal Procedures
Routine Instruments, Equipment, and Supplies
Instrumentation for Rhinoplasty differs from the instrumentation for
internal nasal and sinus surgery. endoscopic sinus surgery requires
specialized instrumentation and auxiliary equipment
Nasal Procedures
Routine Instruments, Equipment and Supplies
Routine equipment for most nasal procedures includes the following:
Headlamp, ESU, Power drill, Insulated ESU with suction attachment,
Bipolar unit
Routine supplies include: Basic back table pack, bar drape,
U-drape, prep set, basin set, gloves, 10 and 15 blades, ESU pencil,
bipolar forceps, suction system
Nasap Procedures
Practical considerations
The patient is placed in the supine position with the head placed in
a donut or foam headrest, or a roll is placed inter the scapular
region, to slightly tilt the head back.
Nasal Procedures
Practical considerations
The use of a small prep stand may be requested to hold the supplies
necessary for administering local anesthetic. The supplies for this
"Clean" setup include:
2 medicine cups, 2 control syringes,2 25 or 27 gauge needles,
packing material, local anesthetic with or without epi, topical
anesthetic, nasal speculum, bayonet forceps, small scissors
Submucous Resection (SMR)
SMR indicated that the mucous membrane lining the nasal cavity will
be incised ad the underlying perichondrium or periosteum lifted. The
structures underlying the mucous will be removed to help restore
normal breathing. the mucous membrane is then lad back into position
and held there with the nasal packing material. An absorbable suture
may be placed at incision site
SMR/Septoplasty
Surgical Anatomy and Pathology
The nasal cavity is divided into 2 chamber by the nasal septum.
Anteriorly, the septum is cartilaginous; posteriorly the septum has
bony attachments to the ethmoid and vomer bone. The septal cartilage
is also known as the quadrilateral cartilage.
SMP/Septoplasty
Surgical Anatomy and Pathology
A deviated septum is seen during visual examination. If deviation is
severe, the patient may experience difficulty breathing due to
obstruction. The patient may also suffer sinusitis because of ostium
blockage, resulting in failure of the affected sinus to drain.
SMR/Septoplasty
Preop tests
Radiographs
Sinuscopy
SMR/Septoplasty
Equipment and supplies
See card 7
SMR/Septoplasty
Preop Prep
see cards 7 and 8
SMR/Septoplasty
Surgical Procedure
Cocaine-soaked cottonoids placed preop are removed
SMR/Septoplasty
Surgical Procedure
Nostril on affected side is opened with a speculum and incision made
in mucous membrane and perichondrium
Cartilage is incised and mucous membrane is elevated
Deviated structures or bone sours of the septum, vomer, and/or
ethmoid are reduced or removed.
SMR/Septoplasty
Surgical Procedure
A chisel and mallet may be used. the ST may be asked to
"tap" the chisel held by the surgeon with the mallet.
Bayonet or Takahashi forceps will be needed to extract the tissue remnants.
SMR/Septoplasty
Surgical Procrdure
Hemostasis is achieved
The incision may be sutured or the tissue replaced and held in
position with packing material
Internal splints may be used
Dressings that may include and external sling is applied. Provide
"mustache" dressing and external splint if requested.