NOSE INSTRUMENTSTHUDICUM NASAL SPECULUM * Consists of U-shaped metal spring with two blades at its ends * The size of the nasal speculum should be chosen according to the age of patient and size of the nose * Held in the left hand, assists in widening the vestibule USES: a. Diagnostic: Anterior rhinoscopy b. Therapeutic: a. removal of foreign bodies b. antral wash c. nasal packing Fig. Thudicum nasal speculum d. Surgical procedures inside the nosePOSTERIOR RHINOSCOPY MIRROR * Bayonet-shaped handle so that examiner’s hand does not block vision * Mirror is available in sizes of 0 to 5 and should be of an appropriate size so as to pass behind soft palate and * reflect sufficient light for the image to be seen + Plain mirror and does not magnify the image USES a. Posterior rhinoscopy b. to examine the postnasal space after adenoidectomy to look for remnants if anyKILLIAN’S LONG BLADED NASAL SPECULUM USES: a. Diagnostic: Anterior rhinoscopy-nasal septum, Little’s area, lateral wall of nose, nasal cavity b. Therapeutic: a. removal of foreign bodies b. antral wash c. nasal packing d. surgical procedures inside the nose like polypectomy, SMR, septoplasty etc Fig. Killian short and long bladed nasal speculumTILLEY’S DRESSING FORCEPS * Box joint * Bayonet-shaped * Obtuse angle * Prevents surgeon’s hand from obstructing line of vision USES: a. Nasal packing b. Ear dressing c. FB removalTILLEY ANTRAL HARPOON + It has one antegrade pointing tip and three retrograde pointing tips * While the instrument is removed, a piece of bone could come out thereby enlarging the antrostome USES: a. Intranasal antrostomy for drainage in inferior meatus of chronic maxillary sinusitis b. as an adjunct procedure during Caldwell-Luc surgery ADVANTAGE: It removes the bony chips when it is withdrawn, so the bony chips do not fall in the sinus cavity Fig Tiley oniral harpoonTILLEY’S ANTRAL BURR USE: It enlarges and smoothens the hole made by harpoon in intranasal inferior meatal antrostomy. Fig. Tilley antral burHIGGINSON SYRINGE * It has a bulb with red rubber tubing on either side * One end has a valve and the other end has a nozzle * The valve allows only inflow of water into the bulb * The valve end is kept in water and the nozzle end is connected to the antral wash cannula * Capacity of the bulb is about 50 ml a * Syringe is made up of red rubber material USES: a. Antral wash Fig. Higginson syringe b. Nasal douching in atrophic rhinitisFREER’S DOUBLE ENDED MUCOPERICHONDRIAL ELEVATOR USES: a. To elevate mucoperichondrial and periosteal flap in septal surgeries b. For displacement of inferior turbinate in antrostomy operation c. For elevating canal skin and cartilage perichondrium in mastoid surgeries d. For elevation of mucosa in Caldwell-Luc operation e. To spread and tease temporalis fascia graft f. To perform uncinectomy F ig Freer double-ended mucoperichondrial elevatorBALLENGER SWIVEL KNIFE * Knife that can rotate 360 degrees within its two prongs, hence, can be positioned without rotating the instrument and the direction can be changed * Consists of handle, shaft, head and a blade * Blade is fitted by swivel joints to the handle so that the blade can rotate through 360” in the joints USES: a. In submucous resection of septum b. To harvest cartilage for rhinoplasty and tympanoplasty METHOD: = Introduced in a cut of the nasal septal cartilage and is pushed backwards, then downwards and_ finally forwards = The blade of this knife (available in different sizes) revolves automatically and changes direction while cutting the cartilage anteroposteriorly, downwards and posteroanteriorly 3HEATH MALLET Appears like a hammer Used along with a gouge, chisel or osteotome The gouge is to be hit by a mallet with movement at the wrist during septal surgery Fig Heath malletJENKIN MASTOID GOUGE * Has a curved rounded tip that has smooth beveling, hence, cuts bone in a circular pattern * Held at an acute angle to the bone for cutting it and a mallet is used for hitting on it . Replaced by electrical drill in the present ay USES: a. Remove hard bone during mastoidectomy b. Caldwell-Luc operation Gs pcos of exostosis in external auditory cana’ Fig Jenkin mastoid gougeLICHTWITZ TROCAR AND CANNULA * Parts—handle with long pointed end, cannula with connecting end for irrigation PROCEDURE: * Antral puncture is done in the inferior meatus 1 cm behind the anterior end of inferior turbinate * Trocar and cannula is directed towards the outer canthus of ipsilateral eye * Trocar is now withdrawn from cannula * Valve end of Higginson syringe is dipped in the warm water * bulb is squeezed and the sinus is irrigated with water after connecting the syringe to the cannula * patient is advised to breathe through the mouth USES: a. Diagnostic proof puncture: to obtain aspirate of the maxillary sinus b. To drain pus in maxillary sinusitis . Instillation of medicine into maxillary antrum Tilley Lichwitz trocar and cannulaNASAL POLYP