Nasal Forceps Research Articles

Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to Preserving the Bony Cap While Dehumping.

For V-shaped nasal bones, the authors consider that ostectomy of the dorsal keystone area can be avoided, and this has led to the development of a new preservation technique: the spare roof technique B (or Ferreira-Ishida technique), where the bony cap is preserved. It includes six main steps, as follows. Step 1, draw on the surface of the skin the desired dorsal brow-tip aesthetic lines, the pyriform aperture, the rhinion, and the amount of triangular bone that has to be taken out to allow pushing-down the bony cap, and the transversal line in the beginning of the nasal hump. Step 2, release the upper lateral cartilages from the dorsal septum ("high septal strip"). Step 3, take out the amount of dorsal septum necessary to dehump. Step 4, perform the paramedian high parallel osteotomies exactly below the marked brow-tip dorsal aesthetic lines. Then, perform the second group of lower osteotomies, until the E-point, to achieve a triangular shape of bone in each side of the bony cap. Perform the ostectomy of the mentioned triangular areas. Release the lateral keystone area. Perform partial ultrasonic ostectomy endonasally, below the nasal bones, to promote the weakening of the transverse fracture line, in the sagittal plane just above the E-point. Push-down gently the rectangular bony cap with a Luc nasal forceps (19 cm) in a greenstick fashion. Perform lateral traditional osteotomies from high to low to high to narrow the bony bridge as much as is needed. Step 5, perform a regular L-shape Cottle septoplasty (if necessary). Step 6, suture the cartilaginous middle vault (upper lateral cartilages) to the dorsal aspect of the remaining septum.

Nasal myiasis among pediatric patients: Our experiences

Objective: The objective is to study the clinical profile, diagnostic method, treatment, and outcome of nasal myiasis among children at a tertiary care teaching hospital of east India. Materials and Methods: This is a prospective study on 28 children of either sex with the age group of 6–16 years suffering from nasal myiasis during the past 10 years. The details clinical pictures, treatment, and outcome of the nasal myiasis among children were studied. Nasal endoscopy was performed for the diagnosis and removal of crawling maggots by picking up with nasal forceps under direct vision. Results: The youngest child was of 6 years 3 months and oldest 16 years of age. More than half of the children (60.71%) were >10 years of age. Of 28 children, 18 (64.28%) were suffering from chronic rhinosinusitis, whereas 5 (17.85%) children with atrophic rhinosinusitis and 5 (17.85%) children were known case of sinonasal tumors. Main presenting symptoms were as follows: epistaxis (100%), a fouls smell (64.28%), passage or crawling sensation of worms (89.28%), and pain in the nose (75%). Endoscopic method was used in all cases for the removal of maggots from the nasal cavity. Conclusion: Nasal myiasis is an uncommon clinical condition in the pediatric age group due to improved living standards, but it still exists in developing and underdeveloped country. Quick and complete removal of maggots is needed for avoiding complications of nasal myiasis among children. The hygiene of the child should be improved for avoiding this dreaded clinical entity.

Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction: Our Experience.

To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (p < 0.05). The mean age of the patients was 35.3 ± 15.89 years, with 23 male and 37 female patients, the 2 groups having a similar male:female ratio. An overall success rate of 90% was achieved at the end of 1 year with no statistically significant difference between the groups. Postoperative complications like tube displacement and punctal, canalicular injury were more in the intubated group. The average osteotomy size was 8.06 ± 5.4 mm at the end of 1 year. Transcanalicular laser-assisted dacryocysto rhinostomy, with endonasal augmentation, is a scarless, effective, daycare procedure, for treatment of primary acquired nasolacrimal duct obstruction with no additional advantage offered by silicone intubation.

Intranasal Splints: Use Of A Readily Available Material

Splinting the nasal cavity after nasal surgeries is a common practice to prevent nasal synechiae formation. Silicone rubber splint is common but usually not readily available. We describe the use of polyethylene containers as a cheap and readily available alternative. Our experience showed that it is safe and well tolerated by patients. INTRODUCTION Nasal synechia is a challenging complication following nasal surgeries, splinting the nasal cavity is usually done to prevent this complication 1. Silicone rubber splints are in common use 1 though other substitutes such as x-ray films, Teflon have been described in medical literature 2, 3. In our practice environment there is scarcity of silicone splints because of high costs of importation. We describe the use of empty containers of intravenous (IV) fluids and drugs as a nasal splint. METHODS An empty plastic container of intravenous drug or fluid is collected. A scissors is used to fashion the splint from the container appropriate to the nasal cavity after surgery. Fig.1 Care is taken to prevent sharp points by ensuring rounded ends at all sides. The splints is then cleaned thoroughly with cetrimide and rinsed with normal saline. The patient is seated comfortably and the procedure thoroughly explained to the patient. The nasal cavity is sprayed with a local anaesthetic agent: 10% xylocaine with 1:100 000 adrenaline. After a wait of ten minutes for the anaesthesia to take effect, the splint is inserted into each cavity with the aid of a Killian's nasal speculum, Tilley's nasal forceps and headlight. The splint is coated with a lubricant before insertion and it should be slid along the floor of the nasal cavity gently, it must never be forced in. Care is taken to ensure that the splint stays between the septum and the lateral nasal wall. The edges of the splint must not protrude into the vestibule as this might cause discomfort, the anterior end lies at the level of the posterior edge of the columella. Fig.2 The splint must not be tiny relative to the nasal cavity to avoid inhalation. Topical decongestants are prescribed post operatively for five days. The splints stay in situ for an average of 2weeks before removal.

Front-loading of Groningen voice prosthesis in alaryngeal patients requiring prosthetic replacement.

The Groningen voice prosthesis can be successfully replaced using the back-loading system. We have attempted to minimize patient stress by developing a front-loading system that does not require insertion of the introducer via the tracheo-oesophageal shunt to the oral cavity or the mesopharyngeal anaesthetization regularly used with the back-loading system. Using our front-loading system, the existing prosthesis is removed, then the posterior portion of the replacement Groningen prosthesis is grasped by a pair of nasal forceps with a small jaw to make an acute angle and inserted into the oesophageal cavity through the shunt at a stroke. All 20 patients who underwent forward-loading replacement of a Groningen (n = 17) or Blom-Singer (n = 3) valve with a Groningen valve tolerated the procedure well and experienced no complications except, in some cases, for minor bleeding just after insertion of the prosthesis. The procedure was completed within 30 seconds.

Management of nasal injuries: a postal questionnaire survey of UK ENT consultants.

Nasal injuries are one of the commonest conditions seen in ENT out-patients. There is no uniform policy or protocol for the management of this condition. A postal questionnaire was sent to all UK-based ENT consultants. The aim of this study was to ascertain current practice in the management of this common problem. We were also interested to know if consultants believed that the septum should be addressed and dealt with at the same time as manipulation to improve cosmetic and functional results. Manipulation of nasal bones without anaesthesia, under local anaesthesia, and general anaesthesia with digital pressure or using instruments are all practised. The digital pressure under general anaesthesia with use of septal and nasal forceps, if needed, is practised by the majority of consultants (55.8 per cent). Only a minority considered the role of the septum to be important in the initial management of the patient.

Secondary Shunt Procedure for Alaryngeal Patients in an Outpatient Clinic

The shunt procedure used for laryngectomized patients undergoing secondary tracheo-esophageal (T-E) puncture is inconvenient and causes stress to the patient. In order to overcome these problems we developed a novel surgical T-E shunt technique using the Groningen voice prosthesis that does not require esophagoscopy or general anesthesia and can be performed in an outpatient clinic. In this procedure, a shunt is created using a pair of nasal forceps with the patient seated. An endoscope with biopsy forceps is used to insert the Groningen voice prosthesis. The procedure is usually completed within 20 min after inducing local anesthesia. Neither the technique itself nor the time taken to complete the procedure differed for T-E and tracheo-neoesophageal (reconstructed with flap) shunting. We believe that this procedure is suitable for patients who are afraid of esophagoscopy and/or are not considered suitable candidates for esophagoscopy and repeated general anesthesia. The procedure is also beneficial for both patients and surgeons with regard to its duration and the cost-effectiveness of treatment.

A review of anaesthetic technique in 15 paediatric patients with temporomandibular joint ankylosis.

Temporomandibular joint ankylosis presents a serious problem for airway management. This relatively rare problem becomes even more difficult to manage in children because of their smaller mouth opening with near total trismus, and the need for general anaesthesia before making any attempts to secure the airway. A technique for securing the airway that combines local blocks for nerves of larynx and topical anaesthesia of upper airways for placement of these blocks, and minimal general anaesthesia for these manoeuvres, is described. For general anaesthesia, a combination of halothane and ether by spontaneous ventilation, using bilateral nasopharyngeal airways, was used. Because of the severe trismus, a tongue depressor or tip of a laryngoscope was used with a fibreoptic light source in the buccal sulcus to visualize the tracheal tube in the pharynx. Nasal forceps, with a smaller tip and narrower blade than Magill forceps was used to guide the tracheal tube towards the air bubbles coming out of larynx. No attempt was made to visualize the larynx, but its position was guessed from the direction of these air bubbles. We review the anaesthetic technique in 15 such cases of severe trismus managed successfully between 1986 and 1999.

Nasal foreign bodies in children.

Between 1994 and 1997, a total of 72 nasal foreign bodies were removed from 68 children (28 girls and 40 boys, including 2 repeats) in the ENT Department at Robert Debré Hospital, Paris. Ages ranged from 1 to 12.5 years (median, 3 years). Two children had bilateral foreign bodies. The unilateral foreign bodies were on the right side in 67.6% of cases. The most frequent objects were plastic objects, beads, paper, cotton and foam. Insertion was witnessed by an adult or reported by the child himself in the majority of cases. The other cases were diagnosed when complications occurred (as seen by persistent rhinorrhea and a foul body odor). All foreign bodies were removed in the consultation room using a hook or nasal forceps.

A proposal for endonasal middle meatal antrostomy

With increase of cases with mild chronic sinusitis, especially the cases combined with nasal allergy, endonasal sinus surgery has been substituted for Caldwell-Luc or some other modified sinus surgery in recent years. The classical inferior meatal antrostomy for maxillary sinusitis is one of the treatments of choice, though this opening is easily closed and is somewhat different from normal sinus physiology. In the middle meatal antrostomy, the opening was made via the inferior turbinate or the middle meatal wall perforated with nasal forceps. Reported here is a new technique for middle meatal antrostomy which can be easily and safely performed. At the beginning, mucosal incision is made from the agger nasi to the anterior of the inferior turbinate, dividing the mucous membrane inferomedially. Then the mucous membrane of the inferior turbinate is cut along the upper margin of it and reflected downwards. With this procedure, the frontal process of the maxilla, lacrimal bone and inferior turbinate are well exposed and well oriented in the surgical field. The pars membranacea is then cut from anterior to inferior, and removed with the uncinate process, thus entering the maxillary antrum. The antrostomy opening is made at least 1 by 1.5 cm wide. Then, the intranasal ethmoidectomy is usually done and the reflected mucous membrane of the inferior turbinate returned to its normal position. This surgery was applied to 34 patients (7 children, 27 adults), (2 antrochoanal polyps, 5 optic neuritis, 3 maxillary sinusitis, 17 pansinusitis, and 7 pansinusitis associated with nasal allergy). We have not experienced surgical complications and none of them also had closure of the antrostomy opening.(ABSTRACT TRUNCATED AT 250 WORDS)

BEAD; A DIFFICULT TRACHEOBRONCHIAL FOREIGN BODY TO RETRIEVE; BRONCHOSCOPIST PERSPECTIVE.

To know the efficacy of different instruments in retrieval of bead from tracheobronchial tree.BACKGROUND: Bead is uncommon object in western world and therefore rarely recorded as aforeign body in tracheobronchial tree. No specific instrument being named for its retrieval. Our studyfocuses on different instruments we used and its outcome.MATERIAL AND METHODS: This was retrospective study of foreign body bead impaction intracheobronchial tree. All patients subjected to bronchoscopy with definite clinical findings of beadimpaction on radiology or bronchoscopic examination were recorded, with different instruments used. Inall cases Karlstorz rigid bronchoscopes of size 3.0 to 5.0 with fiber optic light used. Long bronchoscopicscrew forceps, malleable forceps. Large nasal killian forceps was used after tracheostomy in some cases.Study period: 1st January 2008 to December 2012.Site: ENT A unit Hayatabad Medical Complex Peshawar.RESULTS: In our study of 3 years 32 cases were recorded with bead impaction in tracheobronchealtree. 21(65.62%) were male and 11 (34.37%) female. Age ranges below 1 year was 1 (3%) case,between lyear and 2 years 6 (18.75%) cases, 2 years to 3 years 21(65.62%) and 3 years and above 4(12.5%) cases recorded. 21(65.62%) beads were retrieved with malleable forceps, 8 (25%) with longscrew forceps, 1 (3%) after tracheostomy with long killan nasal forceps and 2 (6.25%) impacted beadswere referred to cardiothoracic department for thoracotomy. 3 (9.37%) beads were impacted in maintrachea, 19 (59.53%) in right main bronchus and 10 (31.25%) in left main bronchus.CONCLUSION: Bead is one of the difficult foreign body tracheobroncheal tree and needs specialinstruments for its removal.KEY WORDS: Beeds, Boronchoscopy,

Modification of Tear Sac Operations

<h2>Abstract</h2> The author's modification is designed to prevent hemorrhage during or after operation, and to promote primary healing. After removal of the sac and trephining, a folded strip of gauze is inserted in the trephined opening, by way of which it is afterward pulled on out through the nose with a pair of nasal forceps. A little of the gauze pack is withdrawn daily through the nose and cut off. The modification may be applied to every type of external dacryocystorhinostomy.