RHINOCON 2017 AMRITSAR

Moderating a panel discussion on " Controversies in Rhinoplasty" The session was chaired by Dr. Arun Aggarwal and Dr. Nilima Gupta and Panelist were Dr. Aru Handa, Dr. Mohan Jagade, Dr. Nitin Gupta, Dr. Jasveer Singh.

Surgeon's life.

It's a team work where your anesthetist, technician, assisting nurse, circulating nurse and other staff contributes to success of your case. These people are your family then and it is utmost important to listen to them.

Infection of the Danger are of the face.

Take such kind of infection seriously. Danger area of the face consists of upper lip and adjacent nose. An infection of this area quickly reaches cavernous sinus through network of veins and becomes life threatening. Infection occur here commonly through hair follicles present in the nose.

This is common in diabetic person or in those who picks their nose frequently.

Treatment involves antibiotic often from penicillin group and local Mupirocin ointment locally. sometimes an incision and drainage have to be done especially if patient does not respond to medicines in first 24-48 hours. Keep blood sugar in check if person is diabetic.

Cellulitis of the tip of the nose.

Da Vinci Robotic surgery

     I attended the first National workshop on robotic surgery of head and neck.  I was invited as Guest faculty by Professor Ashok Kumar Gupta a data I moderated a live surgical session.  

I could get hands on the Da Vinci Robotic surgery system and could see trans axillary thyroidectomy (RATS), retro auricular thyroidectomy, radical tonsillectomy and trans oral robotic surgery of base of tongue lesions (TORS).  

Humble thanks to Professor Ashok Gupta and Professor Naresh Panda for giving this opportunity.   

Life member association of Phonosurgeons of India

 

Antrochoanal polyp

Adult Adenoidectomy & Tonsillectomy with coblation procise wand

Sleep Apnoea surgery

Palatal collapse can be anterior to posterior or lateral. both can be observed in same patient during the same night. So a circumferential palatoplasty should always be done

Ideally Dise should be done for 10-12 mins till you see proper Apnoea.

Use thin endoscope as far as possible and thick diameter endoscope may cause static obstruction as well.

Scope should be kept above the velum

Velum is not a 2 dimensional structure. It is a tube and it starts from the attachment of soft palate.

If soft palate is narrow higher up then any surgery would fail and 10-15% are such cases. In such cases anterior palatoplasty can be offered but still results are disappointing.

Glossoepiglottopexy is preferred over epiglottectomy

Palatopharyngeus muscle is key to any palatal surgery.

Scar formation plays a key role in final result so 3-6 months should be waited for final result.

Contraindications for sleep apnoea surgery

BMI above 30 is relative and above 40 is absolute contraindications for sleep apnoea surgery 

Static obstruction should be removed always 

• DO YOU ALWAYS GO FOR WT REDUCTION PROGRAM / OWP 

THERAPY BEFORE ANY KINO OF 

DBWTTE THERAPY ?

Answer tailored according to need of patients 

How long

Vary.  

3 days trial prior to taking for surgery 

Patient choose the length of conservative treatment 

AHI 

Between 30-40 may need CPAP

Above 40

70 needs CPAP and it's more of a problem of Anaesthesia 

It's more the length of apnea period that matters. 

ISSACON 2017

 

Laser Arytenoidectomy

 For prolapse arytenoids after laser Arytenoidectomy 

It may result in formation of granuloma 

Mitomycin works 2/3 weeks after wound healing so it has no effect at the time of surgery 

It is expensive also 

Wound healing has three phases

Inflammation immediate 

Proliferation 2nd day 

Maturation 2 weeks 

eschar can be removed at second stage when mitomycin can be applied 

Don't inject epinephrine in larynx as it may stop bleeding then but bleeding may start later when it's effects is off.