17 - Otorhinolaryngology-head and neck surgery

Summary

Introduction

Otorhinolaryngology-head and neck surgery (ORL-HNS) is a relatively new surgical subspecialty. It offers many challenges to the surgeon and his or her assistant because of the diversity of structures operated upon. These include the ear, nose, mouth, throat, larynx and neck. Thyroid and parathyroid surgery is being performed increasingly by head and neck surgeons, and facial plastic surgery is comprising a greater part of the ORL-HNS workload. Access to these structures is often limited and many of the structures are small, requiring either a microscope or endoscope to provide magnification for adequate visualization for surgery. Due to the proximity of vital structures, such as the brain, cranial nerves, eyes and large vascular structures, surgery can be very challenging and sometimes stressful. Some cases provide an extra challenge to both the anaesthetic and surgical teams by having compromised upper airways.

Preparation of the patient

As an assistant, it is always beneficial to your medical education, and often helpful to the smooth running of the surgical team, if you familiarise yourself with the patient's case-notes pre-operatively. Because of the complicated anatomy of the area, having the patient's CT or MRI scans available in the operating room is often important, and when possible you should review the scans on the light-box or computer screen preoperatively. For ear cases, locating the latest pure tone audiogram in the case-notes and knowing the extent of hearing deficit is advantageous. For all operations being performed on one side only, it is a potentially useful safeguard for you to know which is the correct side (see also p. 21).