OTORHINOLARYNGYOLOGY 3RD YEAR CLINICAL ATTACHMENT

se of Simple Administration Error

Kolluru

AIMS AND OBJECTIVES

Discuss:

About The Patient;

Histo ! O" P esentin# Co$%&aint; Obse 'ations An( E)a$inations; P e * O% Assess$ent; Past Me(ica& Histo !; Me(ication Histo !; +ocia& Histo !;

O%e ation,Me(ica& Inte 'ention

-unctiona& En(osco%ic +inus +u #e ! .-E++/ P&us E)cision o" in'e te( %a%i&&o$a

A out The !atient " #istor$ Of !resentin% Complaint

M 0 H1;
23 !ea o&( $a&e .D0O040 55,67,5378/9 Reti e( -a $e 9

P esente( :ith:
Le"t Nasa& Obst uction; Dec ease( Ai "&o:; Occasiona& Pain a oun( the sinuses; ;ses his i#ht nost i& "o his b eathin#; ;ses a %i&&o: at ni#ht; No othe $a<o % ob&e$s; Doesn=t e""ect his (ai&! &i"e $uch because he uses his i#ht nost i& "o

co$%ensation

E&amination

>estibu&a +tenosis on the RIGHT si(e; Po&!% on the LEFT si(e; On "u the e)a$ination;
Oncocyte Schneiderian Papilloma .In'e te(

Pa%i&&o$a/
Le"t Mi((&e Meatus Lesion :as "i&&in# the Le"t Ma)i&&a ! +inus

!atholo%$ E&amination

Patho&o#! e%o ts su##ests;

Line( b! multi layered oncoc!tic e%ithe&iu$ ?

intra epithelial microcysts :ith a co&&ection o" $ic o * abscesses;

No "un#a& h!%hae % esent; E'i(ence o" ch onic but acti'e in"&a$$ato ! ce&&

in"i&t ate in the sub$ucosa;

NO e'i(ence o" $a&i#nanc!;

!atholo%$ E&amination 'Contd(

No in(ication o" intracranial e)tension; Le"t Ma)i&&a ! sinus co$%&ete&! o%aci"ie(; De"icienc! o" the Me(ia& ? Late a& :a&& o"

Ma)i&&a ! +inus
La #e %o&!%oi( &esion on the LEFT nasa& ca'it! +c&e osis o" the LEFT @!#o$a an( LEFT

Pte !#oi( %&ate

Differential Dia%nosis

+Aua$ous Ce&& Ca cino$a A(enoca cino$a A## essi'e -un#a& +inusitis ONCOC TE SCHNEI!ERI"N P"PILLO#"

!ast Medical #istor$

Conditions Recu ent E%ista)is Cata act .Le"t ? Ri#ht/ Hi% Osteoa th itis Recta& Po&!% .Metastatic/ 7667 7667 ear 533B * 7668,6C

Osteoa th itis .NO+ * Dnees ? 5336 E 7667 Pe&'is/ Ch onic L!$%hatic LeuFae$ia 7666 Di'e ticu&itis ;ns%eci"ie( A$b&!o%ia .Le"t/ Mic osco%ic Hae$atu ia O%en * An#&e G&auco$a 5332 533G 533C 5338

!ast Medical !rocedures

Procedures MND .Nasa& +u #e !/ Ri#ht Tota& Hi% Re%&ace$ent Le"t Tota& Hi% Re%&ace$ent Ri#ht Nasa& Caute ! Le"t Nasa& Caute ! ear 5326 5336 7663 533B 7668

H H H H

1ea s Dentu es E) * +$oFe .+to%%e( s$oFin# C6 !ea s a#o/ Occasiona&&! D inFs P e'ious nasa& t au$a

O ser)ation And E&amination

(On Admission)

%ei&ht Hei&ht 'ody #ass Inde( )'#I* Temperature Heart Rate Respiratory Rate SpO+ 'lood Pressure

$alues 5550B D# 5B3 $ 3305 D#$E7 3BIC 28 b%$ 5B b%$ 3CJ 5G3,23

!re " Op Assessment

(As carried on 09/09/2013)
Factors Haemo&lo,in )H,* #ean Corpuscular $olume )#C$* Red 'lood Cell Count )R'C* Platelet Count )PLT* %hite 'lood Cell Count )%'C* $alues -./ )&0L* 2.34 )5L* Normal Ran&e )-1/ -2/ &0L* )2/ 66 5L*

)4 737 7344 )-/e-+0L* -/e-+0L* )-7/ 47/ -/e60L* -1- )-/e60L* -637 )-/e60L* )4 -- -/e60L*

!re " Op Assessment

'*rea + Electrol$tes( (As carried on 09/09/2013)

Factors Sodium Potassium 8rea Creatinine Estimated GFR )eGFR*

$alues -4+ mmol0L 431 mmol0L 934 mmol0L --/ :mol0L 79 mL0min

Normal Ran&e -17 -47 mmol0L 137 731 mmol0L +37 932 mmol0L 76 -/4 :mol0L ./ -7/ mL0min

Sur%ical Mana%ement

Dia#nosis o" Chronic Rhinosinusitis )CRS* ? E;idence o5 In;erted Papilloma Decision o" un(e #oin#:
Functional Endoscopic Sinus Sur&ery )FESS* E(cision o5 the In;erted Papilloma

Medical Mana%ement Of Chronic ,hinosinusitis

E$%i ica& Antibiotic "o the in"ection "o at&east 8 :eeFs o $o e; I$%o tant a(<u'ant $e(ications in CR+ such as $uco&!tics an( to%ica& nasa& ste oi(s to sh inF the nasa& &inin#; +!ste$ic AntiEhista$ines; +!ste$ic O a& Co ticoste oi(s i" necessa ! in case o" %atients :ith nasa& %o&!%osis o +a$%te =s t ia(9 ho:e'e the! ca ! a isF o" o%htha&$ic % ob&e$s as thei si(eEe""ects

-unctional Endoscopic Sinus Sur%er$ '-ESS(

+u #e ies use( to t eat sinus % ob&e$s an( nasa& %o&!%osis; Te&esco%es use( to % o'i(e a sa"e access to the sinuses athe than nu$e ous su #ica& cuts; Ca$e as an( s$a&& a ticu&atin# inst u$ents a e use( to access a&& the sinuses an( esto in# the no $a& anato$! o" the sinuses0 P e * O% CT i$a#in# cou&( be use( to enhance the e""icienc! o" the su #e !

-unctional Endoscopic Sinus Sur%er$ '-ESS( . Indications

+!$%to$atic e&ie" to e" acto ! Ch onic Rhinosinusitis .CR+/; Recu ent Acute Rhinosinusitis; - onta&,+%henoi(a& $ucoce&e; Acute su%%u ati'e co$%&ications o" hinosinusitis .O bita& Ce&&u&itis9 Int ac ania& co$%&ications/ In'asi'e an( Non * in'asi'e "un#a& sinusitis

-unctional Endoscopic Sinus Sur%er$ '-ESS(

In this case:
Ma)i&&a ! Ant osto$! :ou&( be use"u& to c&ea

the o%enin# o" the $a)i&&a ! sinus into the Osteo$eata& Co$%&e) .OMC/0

This :ou&( a&so be essentia& because the

in'e te( %a%i&&o$a has ente e( the $a)i&&a ! sinus b! b eachin# the $e(ia& :a&& o" $a)i&&a ! sinus an( is c ucia& "o e)cision o" in'e te( %a%i&&o$a0

-unctional Endoscopic Sinus Sur%er$ '-ESS(

Intraoperati)e Complications

4&ee(in#,Hae$o ha#e * PacFin# "o hae$ostasis; O bita& >io&ation * e)%osu e o" o bita& "at9 &ea(in# to inc ease isF o" o bita& in<u !; +Fu&& base in<u ! * &ea(in# to C+- &eaF .Ace&&u&a De $a& A&&o# a"t/

!ost " Op Dru% Karde&

!ru& Name !ose Route !ate

Re&ular Non In<ecta,les CETRI@INE 56$# OD "s Re=uired COECODAMOL 36,C66 DICLO-ENAC 7 TA4LET+ KD+ C6$# KD+

PO PO PO P,N

7C,55,7653 7C,55,7653 7C,55,7653 7C,55,7653

ONDA+ETRON 8$#

-inall$

The su #e ! cou&( not ha%%en (ue to so$e $is% int on the su #ica& &ette that the %atient ecei'e(0 O%e ation is no: to be %e "o $e( on the 67,57,7653 :ith a&& bein# co ect0

Summar$

A 'e ! inte estin# case o" Ch onic Rhinosinusitis .CR+/ :ith in'e te( %a%i&&o$a in the nasa& ca'it! e)ten(in# to $a)i&&a ! sinus0 Goo( o%%o tunit! to :itness a 'e ! i$%o tant su #ica& % oce(u e .-E++/ :hich is the on&! cu e "o sinusitis :ith othe t eat$ents bein# s!$%to$atic e&ie"0 Ho:e'e (ue to a($inist ation e o 9 I cou&( not see the o%e ation so a&& the in"o $ation I ha'e on -unctiona& En(osco%ic +inus +u #e ! .-E++/ is %u e&! base( on $! ea(in# $ate ia&0

Than/ $ou )er$ much for $our time