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Jeetu Sidar
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12 views27 pages

Instruments Description

Uploaded by

Jeetu Sidar
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© All Rights Reserved
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& EES . 47 } Nit Fig. 6.41 Negus's artery forceps (replacement forceps) It has a curved tip. Uses Used to replace the straight artery forceps after grasping the soft tissue around the tip of straight artery forceps. Because of curved tip, it is easier to slip the knot around it for ligating the bleeding vessel at a depth and ligature will not slip out during tying due to its curved tip. Xlll. Wilson’s artery forceps (Fig. 6.42) Fig. 6.42 Wilson’s artery forceps Long artery forceps with angulation in the middle and curved tip. Same as the Negus’s artery forceps, not popular. XIV. Negus’s ligature slipper or knot tier (Fig. 6.43) Uses Helps to slip the ligature over the tip of Negus’s forceps during ligation of vessels in the tonsillar bed. Fig. 6.43 Negus’s ligature slipper or knot tier XV. Peritonsillar abscess (Quincy) forceps (St. Clair Thomson) (Fig. 6.44) Fig. 6.44 Peritonsillar abscess forceps (St. Clair Thomson) It has a sharpened and angulated body. Uses Acts both as knife for incision and forceps to dilate the incision in peritonsillar abscess drainage. XVI. Adenoid curette (St. Clair Thomson) (Fig. 6.45) “a Fig. 6.45 Adenoid curette (St. Clair Thomson) Two varieties 1. With cage 2. Without cage Available in 6 sizes approximately 8, 10, 12, 14, 16 and 18 mm blade. Use It is used in adenoidectomy operation. The instrument is held in dagger holding fashion. The cage will prevent the tissue from slipping into the nasopharynx or larynx. The one without cage is used to remove tissue around the eustachian tube as the cage can injure the E-tube. While doing adenoidectomy neck of the patient should be flexed to avoid atlanto-occipital joint subluxation. Another precaution to avoid injury is to bring the adenoid tissue by a palpating finger from lateral Wall to the midline at the onset of surgery and keeping line of dissection strictly in the i __TRACHEOsTomy Ins Fig. 6.46 Tracheal hooks Sharp and blunt. Parts Handle and curved tip. Uses Blunt hook is used to retract the isthmus of thyroid gland to expose trac eal wall. Sharp hook is used to retract cricoid cartilage by hooking at its lower border to stabilize trachea before making Fig. 6.47 Trousseau’s tracheal dilator Parts It is similar to curved artery forceps, but stout, cross action blades without lock mechanism (in case of an artery forceps) while closing the handle the tip closes, but in dilator the tip opens, while closing the handle, Blades are curved with blunted tips (atraumatic), Uses For dilatation of tracheostomy opening at surgery to facilitate insertion of trachestomy tube and also during tracheostomy tube changing. 3. PORTEX TRACHEOSTOMY TUBE CUFFED/NON- CUFFED (Fig. 6.48) Fig. 6.48 Portex tracheostomy tube cuffed/non-cuffed Parts Tube with shield. Flanges for strapping to secure the tube in position. Cuff, with pilot bulb externally to know the cuff status. Obturator for guiding the tube insertion. Uses in trachestomy Advantages of using a cuffed tube e Cuff helps to prevent aspiration and keeps the tube in position. e For positive pressure ventilation e For delivery of general anaesthesia. e Can be used safely during radiotherapy. e More trachea friendly means less injury 4. FULLER’S TRACHEOSTOMY TUBE (Fig. 6.49) It is made of German silver. Parts Outer tube is biflanged and compressible. Inner tube is longer than outer tube with an opening in the posterior wall. This prevents obstruction of outer tube by the secretion and crusting. Inner tube can be easily taken out and cleaned and replaced, Fig. 6.49 Fuller's tracheostomy tube Advantages I. Acts as tracheal dilator as outer tube can be com- pressed. So tracheal dilator is not necessary while in- troducing this particular tube. Il. Opening in the posterior wall allows e Phonation and re-education during decannulation. e Patency of the airway above the tube can be checked by blocking the outer opening of tube. F e Speaking valve can be used with the metal tube. Disadvantages e Flanges are weak and can break and become a for- eign body in the bronchus. e Flanges are sharp and can cause trauma to tracheal wall. (Tracheo-innominate artery fistulas are reported following prolonged use of metal tubes.) e. Cannot be used during radiotherapy. 15. CHEVALIER-JACKSON’S TRACHEOSTOMY TUBE (Fig. 6.50) Fig. 6.50 Chevalier-Jackson's tracheostomy tube Parts It is made of German silver, Outer tube —e Lock mechanism for inner tube Holes on either side for straps ¢ Shield for protection Inner tube — Longer than outer tube to prevent outer tube blocking Obturator —_ ¢ Guides the tube insertion Advantages Speaking valve can be used with the metal tube. Disadvantage e Patient cannot phonate with tube in situ. e Cannot be used during radiotherapy. INSTRUMENTS USED IN EXAMINATION AND SURGERY OF EAR 1. Head Mirror Fig. 6.51 Head mirror Parts Concave mirror 3 Y inches in diameter % inches in diameter round aperture Fibre forehead band Use Has a focal length of 18 em Used to focus light from the bull’s lamp. The distance between the bull's lamp and the examiner is about 30 cm. 146 Clinical and Operative Methods in ENT and Head & Neck 2. The "Bull's Eye" lamp (Fig. 6.52) Comes in 3 sizes. Introduced by Sir William Wikk in 1844. ‘ ee Uses ° In examination of ear e In ear surgeries Se - = ii Other varieties of ear_speculum— 1, Gruber 2 Heath 3 Yearsley 's 4 Turner’s ——— 5 Tumarkin’s 4. Jobson Horne’s probe and ring curette (Fig. 6.54) Fig. 6.54 Jobson Horne’s probe and ring curette Parts Has got a serrated end and ring curette at the other end. Uses Serrated probe end is used as cotton wool swab carrier to clean aural discharge. To trace a sinus tract. Curette 1s used to remove foreign body, wax, granulation tissue. Fig. 6.52 The “Bull's Eye” lamp 5. Gardiner Brown’s Turning fork (Flg. 6.55) History In 1855 Heinrich Adolph Rinne (1819-1868) described the tuning fork test, which is still the best method for diagnosis of conductive versus sensorineural hearing loss. Gives an illumination of about 200 candle power without any image of the filament, and can be raised or lowered on the floor stand. 3. Toynbee’s ear speculum (Fig. 6.53) — et * Fig. 6.55 Gardiner Brown's turning fork Fig. 6.53 Tonybee’s ear speculum . Hz, 512 Hz and 1024 Hz. In tuning fork tests viz. Rinne’s test, Weber’s test, absolute bone conduction test. Other types of tuning fork e Hartman’s | e Gradenigo’s 6. Simpson’s Aural Syringe (Fig. 6.56) Fig. 6.56 Simpson's aural syringe e Is made up of metal (stainless steel) e Has a capacity of 150 ml e Has two short pipes one bulbous and the other conical Uses e Removal of FB e Removal of wax e In otitis externa to wash out fungal debris in case of otomycosis. e What do you use for cleaning in syringing? Warm water at body temperature. Hot water causes burns, cold water causes caloric stimulation (vertigo), Contraindications of syringing: e Perforated tympanic membrane Commonly used frequencies in clinical examination: 256. « Patients with history of head injury where there is pos- sibility of temporal bone fracture / CSF otorts pos- * Hygroscopic foreign body pa Techinque It is done in sitting position with the head bent to the side of the ear to be irrigated. A macintosh drape has to be applied to the patient. To collect the irrigated fluid along with debris a kidney tray has to be placed over the shoulder. Pinna should be pulled upward outward and laterally and a jet of saline should be directed posterosuperiorly this is because posterosuperior meatal wall is shorter than anterior wall and floor. Complications e Vasovagal attack e Injury to the external auditory canal and tympanic mem- brane e The foreign body may get impacted. Note Suction and instrumentation under direct vision using an operating microscope is the safest method to remove foreign body or wax. Fig. 6.57 Rose eustachian tube catheter 7. Rose eustachian tube catheter (Fig. 6.57) Metallic catheter with a curved proximal end and ring at its base. It is 12 to 15 cm in length. Uses e To know the patency of the eustachian tube. e To inflate the middle ear. e To install medications to the middle ear. e Remove foreign body from the nose. e Used as a suction cannula. Note Complications - causes trauma to the Eustachian tube. 148 Clinica! and Operative Methods in ENT and Head & Neck Other tests to evaluate eustachian tube patency e Valsalva maneuver e Siegalisation e Politzerisation e Toynbee’s maneuver e Frenzels’ maneuver e Radiological evaluation basal or submento- Vertical view, salpingography CT scan MRI e Diagnostic nasal endoscopy Procedure of catheterization e Surface anaesthesia by spraying 4% xylocaine. e The catheter is passed with tip downward along the floor of nose till it reaches posterior wall of nasophar- ynx. e Then tip is rotated 90 degree medially and withdrawn anteriorly till it touches the posterior wall of nasal septum. e Now catheter is rotated 180 degree laterally when tip of tube will be at the opening of eustachian tube. By gentle manipulation of catheter at this stage will enable the examiner to enter the tube. e Politzer bag is now attached to the catheter and air is insufflated. e Sound heard in auscultation tube connected between patient and examiner, will give a clue to the status of eustachian tube. Inference e Tubal block—No insufflation sound can be heard. e Partial block—Bubbling sound will be heard. e Stenosis—Whistling sound. e Normal—Insufflated air can be heard clearly. Complications of the procedure « Execessive pain © Epistaxis e Syncope 8. Aural dressing forceps (Fig. 6.58) e Hermann’s aural forceps Tilley’s aural forceps Henter Tods aural forceps Heath’s forceps Fig. 6.58 Aural dressing forceps Uses e In dressing and introduction of medicated pack in the external auditory canal e Removal of foreign body and crust from EAC. 9. Agnew’s myringotome is also know as Politzer's myringotome History Named after Adam Politzer (1835-1920) , foremost teacher of otologic diagnosis of Vienna School. Uses To puncture tympanic membrane to place ventilation tubes in acute suppuratine otitis media, secretary otitis media. 10. Mollisons Self-Retaining Haemostatic Mastoid retractor (Fig. 6.59) Fig. 6.59 Mollison’s seif- retractor retaining haemostatic mastoid n¢ elevation of tan Fig. 6.60 Jenkins gouges after GJ. Jenkins (1874-1939) available in 10 widths Uses It is used in mastoidectomy to explore mastoid antrum and air cells. 12. Farabeuf's elevator with thumb rest (Fig. 6.61) Fig. 6.61 Farabeut's elevator with thumb rest e Made up of stainless steel e Has a cutting edge — Use To elevate the periosteum in mastoidectomy. 13. Lempert's Scoop (Fig. 6.62) Fig. 6.62 Lempert's Scoop ‘mastoid Surgeries to retract soft tissues after Incision Named after Julius Lempert ( 1890-1968). Uses Used in different mastoid operations to curette diseased mastoid air cells and granulation tissue. 14. Macewen's curette; with cell seeker (Fig. 6.63) Fig. 6.63 Macewen's curette; with cell seeker History Named after Sir William Macewen (1848-1924) of Glasgow. Parts Has got two ends, one end curette and the other cell seeker. Uses Scoop is used to scoop out diseased air cells where as cell seeker is used to seek the mastoid air cells and the antrum during mastoid operation. It is also used to identify the aditus. Maximum precaution should be taken to avoid incus dislocation while probing the aditus. Micro Surgical Instruments (Father of micro surgery of ear - Gunner Holmgren (1875- 1954)) 1. Sickle knife: For metal flap 2. Ring curette 3. House curette 4. Knife for meatal skin incision 5. Bayonet shaped elevators for meatal wall 6. Curette for tympanic ring 7 . Fine probe to test the mobility of foot plate of stapes in stapedotomy 8. Mobilizers for severing adhesions involving stapes 9, Oval scoops ~ 10. Oval window fenestrator 11, Straight needle 180 Clinica! and Operative Methods in ENT and Head & Neck > Perpendic ular hook . Wilson's Nibbling forceps For removal of superior mm during stapes mobilization \4. Lempert's Nipper (Fig. 6.64) for Head of Malleus \[Link] Piston 6. Lempert's retractor: Named after [Link] Parts - 4 prongs and handle Uses: In various ear surgeries in retracting the skin by endaural route. |[Link]'s endaural speculum Named after J .Lempert. Fig. 6.64 Lempert's Nipper Uses: Used in endaural incisions. STAPEDECTOMY e Joseph Toynbee-demonstrated by anatomic dissections the common occurrence of stapes ankylosis as a cause of deafness. e Fenestration operation introduced in 1938 by julius Lempert e In 1952 [Link]'s - Endomeatal approach for stapes. mobilisation Stapedotomy set (Fig. 6.65a, b): For stapedotomy operation Contents: 10 instruments a. Incision knife: To make the transmeatal incision. b. Metal flap elevator: To elevate tympano metal flap, Fig. 6.65 a & b Stapedotomy set - House's Curette: For curetting the postero-supe- rior meatal wall for exposure of stapes. . Sharp straight pick: For making a puncture on the foot plate. - 45 Degree & other angled pick (0.5mm): to en- large the puncture and enlarge the fenestra on the foot plate. Crocodile aural scissors: for cutting the stapedius tendon, fibrous adhesions, skin flaps etc. - Crocodile aural forceps: to insert the Teflon piston or other prosthesis, to Temove bits of bone or soft tis sue and to remove Stapes superstructure. . Teflon Piston Diameter: 0.3mm/0.6mm/0.8mm Length: 3.5 mm to 6mm The measurement the lenticular proc in length, is made from the under surface o! €Ss to the foot plate - usually 4m” ficro suction tips used for suctioning blood during the _ DIRECT LARYNGOSCOPE With Sliding Plate Sliding part with proximal or Distal [lumination: Sliding part allows opening of the tube and there by helping in guiding and directing the bronchoscope in case of children and difficult cases. Fig. 6.66 Anterior Commisure direct Laryngoscope Anterior Commisure dire Laryngoscope (Fig. 6.66) Types 1. Chevalier Jackson Advantages ¢ Bright light and clear view ¢Fogging unlikely ¢ Double illumination ¢ Broader so better view, Disadvantages ¢ Heavy and difficult to sterilize. DISTAL ILLUMINATION Advantages Lighter in wt. e Completely sterilized. e Narrow and easy to insert e Unobstructed lumen for passage of instruments. Disadvantages e Less bright light e Fogging due to secretions Advantages of Anterior Commisure Direct Laryngoscope e Anterior commisure can’be visualized better. e Vocal cord can be fixed in on position. e Sub glottis can be examined by manipulation of laryn- goscope. ; Uses Diagnostic e For detailed examination of the hypopharynx; and lar- ynx e For biopsy Therapeutic e Removal of foreign body e Excision of benign tumour or Nodule from the vocal cord. Microlaryngoscope Kleinssaur's suspension laryngoscope system (Fig. 6.67 a, b & c) and operating microscope with 400 mm lens are commonly used for this procedure (Fig. 6.68). Fig. 6.67a Kleinssaur's suspension laryngoscope system Fig. 6.68 Microlaryngoscope Advantages of microlaryngoscopy OVer dire, laryngoscopy are e Precision | » Better illumination and magnification ‘ e Both hands of the surgeon will be ae perform pre. cision surgery | ° un laryngeal surgery can be performed with myc, ease. Hypophryngoscope (Fig. 6.69) Fig. 6.69 Hypophryngosc 1 Indications Diagnostic To examine and rule out growth in the pyriform fossa, posi cricoid region & cervical esophagus performing biopsy. Therapeutic e For removal of foreign bod cricoid region & cervical e Of e Cricopharyngeal dilatation e Use in cricopharyngeal myotomy e Excision of cricopharyngeal web . pyriform fossa, post agus OESOPHAGOSCOPE Name: Chevalier Jackson's Oesophagoscope (Fig. 6.70).

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