ENT Surgery

Question 1

4 sinus compartments

Answer 1

• ethmoid
• maxillary
• frontal
• sphenoid

**susceptible to trauma

Question 2

nasal turbinate

Answer 2

• lateral aspect
• increase surface area
• highly vascularized

Question 3

3 parts of pharynx

Answer 3

• naso
• oral
• hypo

Question 4

nerve supply to airway

Answer 4

CN 5: trigeminal (ophthalmic, maxillary, mandibular)
CN 9: glossopharyngeal
CN 10: vagus

Question 5

palatine tonsils

Answer 5

• very vascular: external carotid, maxillary, facial arteries
• lymphatic system

Question 6

branches of vagus nerve and innervation

Answer 6

• external superior - motor to cricothyroid
• internal superior - sensory to larynx above vocal cords
• recurrent - motor and sensory below vocal cords and motor to cricothyroid

Question 7

larynx location - infant vs adult

Answer 7

• infant: C3-C5

- adult: C4-C6

Question 8

narrowest part of larynx, age which this changes

Answer 8

• infant: cricoid ring
• adult: vocal cords

*at 8 years airway resembles adult

Question 9

larynx unpaired cartilages

Answer 9

• thyroid
• cricoid
• epiglottis

Question 10

larynx paired cartilages

Answer 10

• arytenoid
• cuneiform
• corniculate

Question 11

hyoid bone

Answer 11

• u-shaped

- joins larynx to the tongue

Question 12

glossopharyngeal

nerve

Answer 12

• superior aspect of epiglottis and base of tongue

- gag reflex

Question 13

cases to avoid nitrous oxide

Answer 13

• ear procedures
• laser
• foreign body

Question 14

considerations for ENT

Answer 14

• head of table turned 90-180 degrees
• NIM-EMG: nerve monitoring, *avoid muscle relaxation
• smooth and rapid emergence, *IV lidocaine
• avoid N2O
• minimize blood loss: use epi-cocaine local anesthetic, controlled hypotension (*vascular tumors)

Question 15

complications for ENT

Answer 15

• n/v: suction out stomach, IVF, anti-emetics

- use opioids with caution in children with OSA

Question 16

individuals with elevated oral secretions

Answer 16

• smokers

- African-Americans

Question 17

max doses of epinephrine mixed with local anesthetic

Answer 17

• 200 mg

- 1.5 mcg/kg

Question 18

IM dose - anectine

Answer 18

• 3-4 mg/kg

- 2-3 minutes to onset

Question 19

sublingual dose - anectine

Answer 19

• 0.5-1 mg/kg

- 30 sec-1 min to onset

Question 20

myringotomy and tube placement

Answer 20

• inhalation induction
• mask case
• no IV
• have IM anectine and atropine ready for all kids

Question 21

tonsillectomy and adenoidectomy

“T-n-A”

Answer 21

• oral RAE (cuffed) versus LMA
• shoulder roll to extend neck
• throat pack: make sure it comes out
• suction stomach
• position on side post-op for drainage

Question 22

complications - tonsillectomy and adenoidectomy

Answer 22

• laryngospasm: Larson maneuver, positive pressure ventilation, and SUX
• bleeding: RSI, replace blood, extubate fully awake

Question 23

cleft lip and palate

Answer 23

• difficult intubation
• oral RAE
• NO oral airway, only nasal
• large amount of secretions post-op

Question 24

acute epiglottitis signs

Answer 24

• 2-7 year old
• influenza B
• sitting position with head extended and leaning forward
• “thumb sign” on x-ray

Question 25

acute epiglottitis treatment

Answer 25

- 100% O2 - do not do DL or sedation outside of OR - keep patient calm - downsize ETT by 1 - check for air leak prior to extubation

Question 26

sinus and nasal surgery

Answer 26

- oral RAE | - increased bleeding

Question 27

foreign body aspiration

Answer 27

- common in right mainstem - @ larynx: DVL with magill forceps - @ distal: bronchoscope - spontaneous ventilation with no cricoid or positive pressure - sitting position - use TIVA - check for airway edema prior to extubation - no N2O

Question 28

trach sizing

Answer 28

women: 6.0 shiley with 26 F dilator male: 8.0 shiley with 28 F dilator

Question 29

complications - radical neck

Answer 29

- carotid sinus stretch can elicit vagal response - pneumothorax - venous air embolism - recurrent laryngeal nerve damage - Q-T segment prolongation - high circuit pressures

Question 30

Le Fort facial fracture classification

Answer 30

I: horizontal, below nose to hard palate II: U-shaped, under eyes to bridge of nose III: separation of facial skeleton to cranium

Question 31

facial fracture considerations

Answer 31

- no nasal airways - considered to have cervical spine fracture until proven otherwise - can be opened to brain - need wire cutters at bedside if mouth is wired shut

Question 32

nerve responsible for laryngospasms

Answer 32

superior laryngeal: internal sensory, external motor