Surgery

Tympanoplasty

Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum (tympanic membrane) and/or the small bones of the middle ear Tympanoplasty can be performed through the ear canal (transcanal approach), through an incision in the ear (endaural approach) or through an incision behind the ear (postauricular approach). A graft may be taken to reconstruct the tympanic membrane. Common graft sites include the temporalis fascia and the tragus. The surgery takes ½ to 1 hour if done through the ear canal and 1 and a half to two hours if an incision is needed. It is done under local or general anesthesia. It is done on an inpatient or day case basis and is successful 85-90% of the time.

Septoplasty

septal resection and septal reconstruction,[1] is a corrective surgical procedure done to straighten the nasal septum, the partition between the two nasal cavities.[2] Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Deviations of the septum can lead to nasal obstruction. Most surgeries are completed in 60 minutes or less, while the recovery time could be up to several weeks. Put simply, septoplasty is a surgery that helps repair the passageways in the nose making it easier to breathe. This surgery is usually performed on patients with a deviated septum, recurrent rhinitis, or ossinus issues.

Functional Endoscopic Sinus Surgery (FESS)

Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical treatment which uses nasal endoscopes to enlarge the nasal drainage pathways of the paranasal sinuses to improve sinus ventilation. This procedure is generally used to treat inflammatory and infectious sinus diseases, including chronic rhinosinusitis that doesn't respond to drugs,[3][4] nasal polyps, some cancers, and decompression of eye sockets/optic nerve in Graves ophthalmopathy.In the surgery, an otolaryngologist removes the uncinate process of the ethmoid bone, while visualizing the nasal passage using a fiberoptic endoscope. FESS can be performed under local anesthesia as an outpatient procedure. Generally patients experience only minimal discomfort during and after surgery. The procedure can take from 2 to 4 hours to complete.

Submucous Resection Surgery (SMR)

Submucous Resection (Submucosal Resection, SMR) of the nose is a surgical procedure during which the bony structures of the turbinate are partially removed from below the mucous membrane. It is usually intended to treat a deviated septum causing chronic nasal airway obstruction or chronic nosebleeds. Other reasons include nasal obstruction due to allergy or chronic sinus infections which have not responded to other treatments. SMR may be required for another nasal sinus surgery, when the deviated septum makes the access to other parts of the nose difficult. Sometimes it is performed as part of a cleft lip and palate repair

Mastoidectomy 

A mastoidectomy is a procedure performed to remove the mastoid air cells. This can be done as part of treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma. In addition, it is sometimes performed as part of other procedures (cochlear implant) or for access to the middle ear. There are classically 5 different types of mastoidectomy:

  • Radical Mastoidectomy - Removal of posterior and superior canal wall, meatoplasty and exteriorisation of middle ear.
  • Canal Wall Down Mastoidectomy - Removal of posterior and superior canal wall, meatoplasty. Tympanic membrane left in place.
  • Canal Wall Up Mastoidectomy - Posterior and superior canal wall are kept intact. A facial recess approach is taken.
  • Cortical Mastoidectomy (Also known as schwartze procedure) - Removal of Mastoid air cells is undertaken without affecting the middle ear. This is typically done for mastoiditis
  • Modified Radical Mastoidectomy - This is confusing because it is typically described as a radical mastoidectomy while maintaining the posterior and superior canal wall which reminds the reader of the Canal Wall Up Mastoidectomy. However, the difference is historical. Modified radical mastoidectomy typically refers to Bondy's procedure which involves treating disease affecting only the epitympanum. Diseased areas as well as portions of the adjacent superior and posterior canal are simply exteriorised without affecting the uninvolved middle ear.The structures are preserved to reconstruct hearing mechanism at the time of surgery or in second-stage operation.

 

In Radical and Modified Mastoidectomy the mastoid and middle ear cavities are exteriorized so as not to give the chance for the infection or the cholesteatoma for that matter to spread into the middle cranial fossa.Since the cavities are exteriorized further inspection and cleaning could be done regularly

Thyroidectomy

A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. General, Endocrine or Head and Neck Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland(such as hyperthyroidism) or goiter. Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). Thyroidectomy is a common surgical procedure that has several potential complications or sequelae including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis. Complications are uncommon when the procedure is performed by an experienced surgeon

Tonsillectomy Surgery

For the past 50 years at least, tonsillectomy has been performed by dissecting the tonsil from its surrounding fascia, a so-called total, or extra-capsular tonsillectomy. Problems including pain and bleeding led to a recent resurgence in interest in sub-total tonsillectomy or tonsillotomy, which was popular 60–100 years ago, in an effort to reduce these complications.The generally accepted procedure for 'total' tonsillectomy uses a scalpel and blunt dissection or electrocautery, although harmonic scalpels or lasers have also been used. Bleeding is stopped with electrocautery, ligation by sutures, and the topical use of thrombin, a protein that induces blood clotting.

The main question of importance becomes whether or not the benefits of subtotal tonsillectomy in obstructive sleep apnea are enduring. There have been no randomised controlled trials of long term effectiveness of tonsillectomy for sleep apnea.

Adenoidectomy Surgery

Adenoidectomies began to be routinely combined with tonsillectomy.[2] Initially, the procedures were performed by otolaryngologists, general surgeons, and general practitioners but over the past 30 years have been performed almost exclusively by otolaryngologists.Then, adenoidectomies were performed as treatment of anorexia nervosa, mental retardation, and enuresis or to promote 'good health'. By current standards, these indications seem odd but may be explained by the hypothesis that children might have failed to thrive if they had chronically sore throats or severe obstructive sleep apnea (OSA). Also, children who heard poorly because of chronic otitis media might have had unrecognized speech delay mistaken for mental retardation. Adenoidectomy might have helped to resolve ear fluid problems, speech delays, and consequent perceptions of low intelligence.

Microlaryngeal Surgery

Microlaryngeal Surgery. Microlaryngeal surgery is a minimally invasive procedure used to biopsy or remove abnormal growths, such as granulomas or benign cysts, in the larynx. It is usually performed to correct voice disorders or to diagnose or treat laryngeal cancer.

Submandibular Gland Excision

Surgical excision of the submandibular gland (SMG) is commonly indicated in patients with neoplasms, and non-neoplastic conditions such as chronic sialadenitis, sialolithiasis, ranula and drooling. Traditional SMG surgery involves a direct transcervical approach

Tracheotomy

Surgery on children is more difficult because of their smaller size. Difficulties such as a short neck and bigger thyroid glands make the trachea hard to open. There are other difficulties with patients with irregular necks, the obese, and those with a large goitre. The many possible complications include hemorrhage, loss of airway, subcutaneous emphysema, wound infections, stomal cellulites, fracture of tracheal rings, poor placement of the tracheostomy tube, and bronchospasm"