INSTRUMENTS
BECKMANN ADENOID CURETTE WITHOUT CAGE
Beckmann adenoid curette without
cage
• This is particularly used to remove remnants of adenoid tissue after
adenoidectomy.
• This is also used to remove tubal tonsils without damaging the
eustachian tubal opening.
• Without the cage, the instrument is relatively atraumatic.
DOYEN MOUTH GAG
Doyen mouth gag
• It is a self-retaining mouth gag used to open the mouth by anchoring
on the teeth
• This mouth gag has two blades which are covered with rubber tubing.
• They are set against the second premolars or molars and then opened
• The rubber tubing provides atraumatic coverage over the enamel of
teeth and gums
• It can be used only under general anesthesia
Uses:
a. Glossectomy
b. Soft palate and floor of the mouth surgery
c. Tongue tie release
d. Dental surgery
e. Excision of ranula, benign tumors, cysts and calculus
f. In unconscious patients to open the mouth and prevent airway
obstruction
g. Caldwell Luc operation
Advantages:
a)Self-retaining
b)Avoids the use of a tongue depressor
c)Atraumatic
Disadvantages:
a)Cannot be used in edentulous patients since it fulcrums on the teeth
DIRECT LARYNGOSCOPE
DIRECT LARYNGOSCOPE
• ‘U’ shaped instrument made up of German silver.
• It uses a rigid fiberoptic light carrier for illumination.
• Based on the type of illumination there are two types—Jackson and Negus.
• Position: Barking dog/ Boyce position/ Sniffing position
• Uses: :
1. For examination of larynx, hypopharynx, cricopharynx, and upper esophagus
2. Removal of foreign bodies from the above regions
3. For biopsy from tumors
4. For excision of tumors or nodules from the glottis or supraglottis
5. To assess the extent of laryngeal growth before laryngectomy
• Other instrument with the name Negus:
a. Second artery forceps for tonsillectomy ligation
b. Knot tier and ligature slipper
RIGID ESOPHAGOSCOPE
RIGID ESOPHAGOSCOPE
• It is a long rigid hollow tube of 40 to 45 cm length and 16 to 20 mm
diameter.
• It is available as Negus and Jackson type.
• The Negus type generally has double proximal illumination, tapers
distally and has markings on it.
• The Jackson type has single distal illumination and has no markings
and does not taper distally.
• In distal illumination, the light can get fogged due to its proximity to
the distal end.
• Parts:
a. Handle
b. Eyepiece (Proximal end)
c. Body or shaft
d. Light carrier
e. Distal opening
• Uses:
Diagnostic
a. Malignancy
b. Foreign body examination
c. Cardiospasm
d. Tracheoesophageal fistula
e. Stricture
Therapeutic
a. Removal of foreign body
b. To guide bougies through esophageal strictures
c. Esophageal stenting
d. Sclerosing agent injection into esophageal varices.
• Contraindications:
• Trismus
• Diseases of cervical spine ( cervical trauma, spondylosis, tuberculous
spine, osteophytes and kyphosis)
• Receding mandible
• Aneurysm of aorta
• Advanced heart, liver or kidney disease ( relative contraindication)
Complications:
• Injury to lips
• Injury to arytenoids
• Injury to pharyngeal mucosa
• Perforation of esophagus
Site: Killian’s dehiscence
Clinical feature: surgical emphysema, pain in the interscapular region
• Compression of trachea
ST CLAIR THOMPSON ADENOID ADENOID CURETTE WITH CAGE
St. Clair Thompson adenoid curette
with cage
• This instrument is used to curette the adenoids by a blind technique.
• The curette is introduced behind the soft palate with the blade facing
down. It is held like a dagger and the adenoid is curetted from the
nasopharyngeal wall in the midline by sweeping movement.
• The cage is used to prevent slipping of the excised tissue into the
throat.
• During the procedure, the neck of the patient should not be in too
much extension as it might injure the atlanto-occipital joint.
• Curette without cage:
To remove remnant adenoid tissue
To remove tubal tonsils without damaging eustachian tube openings, since
without cage, the instrument becomes relatively atraumatic
• Differential diagnosis of adenoids:
Adenoids
Thornwald's cyst
Chordoma
Juvenile nasopharyngeal angiofibroma
Antrochoanal polyp
Craniopharyngioma
Meningioma
Grisel syndrome:
• Atraumatic subluxation of the atlantoaxial joint from inflammatory ligamentous
laxity following an infectious process in the head and neck
• It primarily affects children (68% <12years)
• It is thought to be due to the hematogenous spread of septic emboli from the
superior pharyngeal region via the periodontoid vascular plexus.
• The resulting localized hyperemia and inflammatory response cause the
weakening of the atlantoaxial ligaments and joint capsule, leading to
instability.
Clinical features:
• Progressive unrelenting throat, neck pain and stiffness
• Torticollis (cock-robin positioning)
• Paraesthesia
Key Diagnostic Features:
• Clinical:
• Absence of trauma
• Head/neck surgery or upper respiratory tract infection with onset of
torticollis some days after
• Often will have normal inflammatory markers
• Imaging:
• Can be difficult to appreciate on radiographs in the absence of
malalignment
• CT is gold standard, demonstrates atlantoaxial subluxation and rotation
• MRI evidence of inflammatory changes of the surrounding soft tissues,
including disruption of the alar and transverse ligaments, with possible
evidence of associated spinal cord compression
• Severity is graded with the Fielding and Hawkins
classification:
• Type I: Rotatory atlantoaxial dislocation without anterior displacement
of the atlas (ie, atlantodental interval <3 mm)
• Type II: Rotatory atlantoaxial dislocation with anterior displacement of
the atlas by 3–5 mm
• Type III: Rotatory atlantoaxial dislocation with anterior displacement of
the atlas >5 mm
• Type IV: Rotatory atlantoaxial dislocation with posterior displacement of
the atlas
• Differential Diagnoses:
• Congenital:
• Down syndrome: Atlantoaxial subluxation, hypoplastic posterior arch of C1
• Osteogenesis imperfecta: Basilar impression
• Mucopolysaccharidoses, particularly Morquio syndrome: Ligament laxity with hypoplasia of odontoid
• Neurofibromatosis type 1: Hypoplastic posterior vertebral elements, enlarged neural foramina
• Spondyloepiphyseal dysplasia: Vertebral dysplasia
• Os odontoideum: Well-corticated ossicle of hypoplastic dens
• Acquired:
• Inflammatory arthritides: Bony erosions, subluxation, pannus formation, joint effusions
• Vertebral osteomyelitis: Periosteal reaction, marrow edema
• Septic arthritis: Effusion, subchondral bone destruction
• Trauma: Possible fracture of odontoid
• Treatment:
• Conservative management includes bed rest, antimicrobial
therapy, muscle relaxants, anti-inflammatory agents, cervical
traction, and soft or hard collar. Repeat imaging to assess
alignment is required.
• Residual subluxation after 8 weeks of treatment or neurologic
symptoms may require fixation.
• Up to 15% of patients can develop permanent neurologic
sequelae.
PORTEX CUFFED TRACHEOSTOMY TUBE
PORTEX CUFFED TRACHEOSTOMY
TUBE
Parts:
• Single tube with collar
• Cuff
• Balloon with valve for air
• Pilot obturator.
Advantages: Made up of soft material, hence less damaging to the tracheal
wall Since it has a cuff it is particularly useful for intensive care unit patients.
It is useful during radiotherapy . It has a blue radiopaque line all along the
tube for radio logical detection of the site of the tube.
Disadvantages: a. Cleaning the tube is more difficult—requires removal b.
Phonation not possible usually c. Checking the patency of natural air passage
is not possible d. Cuff might injure the tracheal wall (tracheal necrosis) if
overinflated and left for a longer period of time. Pressure should be
FARABEUF’S PERIOSTEAL ELEVATOR
FARABEUF’S PERIOSTEAL ELEVATOR
• Parts: Handle, neck, thumb rest and broad tip.
• Uses:
1. To elevate periosteum over mastoid bone in mastoidectomy
2. To elevate soft tissues and periosteum during Caldwell Luc
operation
3. Can also be used to elevate periosteum and soft tissues during
maxillectomy, lateral rhinotomy and mandibulectomy.
EVE’S TONILLAR SNARE
Eve tonsillar snare
• The snare has a stainless steel wire which is usually 3 inches long with
a thickness of 28 gauge.
• It is used to snare the lower pole of the tonsil after dissection.
• The lower pole is crushed on snaring and thromboplastin is released
which is a powerful vasoconstrictor.
JANSEN MASTOID RETRACTOR
JANSEN MASTOID RETRACTOR
• This is a self-retaining mastoid retractor with three prongs on either
arm.
• The arms are widened by turning a screw.
• Used in mastoid surgeries.
RIGID BRONCHOSCOPE
RIGID BRONCHOSCOPE
• This is a hollow rigid tube with a beveled end. The adult bronchoscope is about
40 to 45 cm long. It has vents on the side for ventilation of the other bronchus
when they remain above the level of carina when inserted into the major
bronchus and hence differs from esophagoscope.
• Parts: a. Handle b. Shaft or body c. Distal beveled end with vents d. Prismatic light
deflector: no loss of lumen space due to light carrier e. Fluvog adapter for
attachment to the proximal end. f. Tube guide g. Rubber sealing cap h. Glass
window plug.
• Sizes: A. Adult—6.5, 7.5, 8.5 B. Pediatric
• Uses: Diagnostic:
a. For examination of tracheobronchial tree for pathology— growth, ulcer,
stricture, etc.
b. Biopsy from a suspicious growth or ulcer
c. Bronchial lavage from secretions.
d. Bronchography.
e. Autofluorescence and photodynamic diagnosis.
• Therapeutic:
1. Foreign body removal
2. Tracheobronchial stenting
3. Aspiration of secretions
4. Removal of tumors
Flexible bronchoscopy Rigid bronchoscopy
Anaesthesia Topical General
Route Nasal or through endotracheal Oral only
tube
Structures seen • Nasal cavity • Nose not seen
• Undistorted view of • Supraglottic area difficult to
supraglottic and glottic areas evaluate
• Segmental and subsegmental • Only segmental bronchi can be
bronchi reached
Bedside exam Possible Not possible
Ventilation Poor control of ventilation Better control of ventilation
especially in children especially in children
Flexible bronchoscopy Rigid bronchoscopy
Foreign body removal • Difficult • Easy
• Contraindicated in children • Ventilation can be done through
scope
• Ideal for foreign body removal in
children and adults
Biopsy Only small piece can be taken Large piece can be taken
Jaw and neck abnormalities or Useful Technical difficult procedure
injuries
Control of hemorrhage Difficult • Better control
• Useful in massive haemorrhage
• The tip of the bronchoscope
can be used to press the
bleeding area
Cost Less More expensive
NEGUS SECOND ARTERY FORCEPS
NEGUS SECOND ARTERY FORCEPS
• It has a curved tip and is used after the first artery forceps for ligating
blood vessels in a deep site.
• The curve may be ‘t’ shaped or ‘j’ shaped
BURKITT FIRST
Birkett straight first artery forceps
• This is used to catch bleeding points in the tonsillar fossa after
tonsillectomy.
• It is replaced by Negus second artery forceps underneath the first
artery forceps before ligation.
KILLIAN BAYONET SHAPED NASAL GOUGE
KILLIAN BAYONET SHAPED NASAL
GOUGE
• This instrument is bayonet shaped to allow the adequate visualization
of the nasal cavity during the procedures.
• The tip of the instrument has a rounded smooth bevelling for a better
grip on the bone. It is always used with a mallet.
• Uses:
1. removal of maxillary crest and spur in septal surgeries.
2. Opening the bone of the canine fossa in Caldwell-Luc surgery.
GWYNE EVAN’S TONSILLAR DISSECTOR
GWYNE EVAN’S TONSILLAR
DISSECTOR
• Initial dissection of tonsil to obtain the proper plane.
• Serrated end is used to cut the tissues from the upper pole, pillars and
the tonsillar bed till the lower pole is reached
LUC FORCEPS
LUC FORCEPS
• This forceps has a screw joint and has a fenestrated tip with sharp
blades that grasp the tissue and cut it.
• Hence, this forceps is suitable for biopsy of various soft tissues and
delicate bone.
• Uses:
• a. SMR or septoplasty for removal of cartilage and bone
• b. Polypectomy and Caldwell-Luc operation
• c. Edge biopsy from oral cavity and oropharynx
• d. Turbinectomy
WALSHAM FORCEPS
WALSHAM FORCEPS
• Used to reduce fractured nasal bones
Asch forceps Walsham forceps
Angled blades Straight blades
No rubber tube on the tip Rubber tube on one tip to protect skin
Gap seen between prongs on No gap seen on approximation
approximation
Used to elevate and straighten the Used to refracture and realign the nasal
septum bones
Stout Smaller in size
WILSON THIRD ARTERY FORCEPS
Wilson artery forceps
• This is a long curved artery forceps with angulation in the middle.
• The use of this instrument is similar to the Negus artery forceps
BALLINGER SWIVEL KNIFE
Ballenger swivel knife
• This is a knife that can rotate 360 degrees within its two prongs.
• Hence, it can be positioned without rotating the instrument and the
direction can be changed.
• This instrument is used in submucous resection of septum and also to
harvest cartilage for rhinoplasty and tympanoplasty.