ENT guide for UG & PG

There’s a nerve called Facial nerve which traverses through our ears on its passage from the brain to the face. The primary function this nerve is to control the muscles of the face concerned with facial expressions, two major functions out of which is the eye opening and maintaining the symmetrical smile.

In cases of fall from heights or road traffic accidents, this nerve gets injured if the person gets impact on the ears. This results in paralysis of the nerve.
Patients often come to us with one sided paralysis of the face, inability to close eyes, asymmetrical smile, inability to chew food on one side, watering from eyes etc,as evident from the picture below.

There’s is a surgical management available called Facial nerve decompression wherein the nerve is relieved off the pressure from the fractured bone pieces or at times a new nerve segment is grafted if there’s a big tear on the Facial nerve.

This patient presented with a Grade V paralysis on the Left side, things did not improve much after 10days of medical management. We decided to proceed for the surgery and the result was quite regarding.
Otology is magic!

Let us revise various terms related to surgical management of the eyeball/globe.

Whenever a young male patient reports at the ER or Out patient with a history of profuse bleeding from his nose, it raises the suspicion of a benign yet fatal tumor called JNA ( Juvenile Nasopharyngeal Angiofibroma). In this case, CT angio scan was done which Showed a large vascular (bright white) mass in the right half of nose predominantly spreading to the surrounding areas & also the opposite side.
CT angio in these cases is helpful in delineating the tumor along with the feeding blood vessels for planning the operative steps meticulously and thus minimizing blood loss. 3D reconstruction & Multiplanar reconstruction helps further in making a mental note how each big blood vessel is entering into the tumor.
The boy underwent surgery which was done endoscopically (through the nose) without any facial scar. 4handed technique assisted by Dr Kaustuv Das Biswas and Dr Soutrik Kumar. The tumour was removed completely with just 1unit of blood transfusion intra-op! Post op CT angio showed no residual with Chopstick sign. The child is presently doing well and is kept on periodic endoscopic surveillance of cavity for any regrowth.
This video consists of surgical steps:
•Surface de-vascularisation using Coblation
•Modified Denker
•Nasolacrimal duct management
•Taking out Posterior maxillary wall
•Dissection & Cauterisation of I-Max
•Management of other feeding vessels
•Segmental resection & Delivery of tumor
•Cavity inspection
•Pterygoid wedge drilling
•Hemostasis securing & Cavity packing

JNA Case 2 (By Dr.S.Hazra)

Let’s revise SOF and IOF

Let us learn about tonsillar enlargement today.

Management of ear canal stenosis is a challenge. 6 year child unfortunately landed up with this following a trauma 1yr back. She had a stenotic plug which was hampering her hearing, apart from the abnormal appearance. After 4months of surgery, kid is doing good and got back normal hearing. Re-stenosis is an issue, for which regular follow-up is being maintained.

Let’s revise Broncho-Pulmonary segments.

Let’s revise Olfactory neuroblastoma and IHC of sino-nasal mass in brief.

Sphenoid sinus can be approached in 3ways while doing a FESS, viz; medial, intermediate and lateral approaches.
Maxillary ridge and maxillary line are two important imaginary lines guiding us during FESS to identify the sphenoid sinus and Naso-lacrimal duct respectively.

This pic is from Renuka Bradoo mam’s book.

Branches of Maxillary artery

Surgical Landmarks of Facial nerve

V2 of Trigeminal nerve