OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

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Excisional Biopsy of Cervical Lymph Node

 Lymph node (arrow) of left posterior triangle being removed for diagnostic purpose.  (White line - sternomastoid surface marking, yellow line - clavicle surface marking, M - mastoid tip, P - lobule of pinna) 

A discrete lymph node (LN) with an intact capsule excised for histopathological examination.  (S - size 15 scalpel blade for comparison)

Excision of Preauricular Mass

Palpable and mobile subcutaneous mass (arrow) which felt hard in consistency.

Localized greyish-white bosselated calcareus mass upon exporation.

The excised specimen measuring about 1.5 cm x 1.0 cm in dimension.  Preauricular lymph node, parotid calculi, and pilomatrixoma are the likely diagnoses..

Tonsillectomy by Using Cold Instruments

 

           Boyle-Davis mouth gag                                 Throat packing

Suspended Boyle-Davis mouth gag in position.

Panoramic view of patient's position from the surgeon's view looking into the throat.

 

Before Surgery                                      After Surgery

                                                                        [By Using Cold Instruments]

 

 

 An example of grasper used to hold and grasp tonsil during tonsillectomy.

 

 Excised tonsils specimens obtained from the same patient with serrated dissector used for its removal shown above it.

 

Watch video of Tonsillectomy by Dissection Method @ MEDtube

 

Curved Negus tonsil artery forceps used to clamp the inferior pole of the tonsil

before its removal and thereafter a tie is knotted for homeostasis.  Presently, better alternatives are available such as bipolar diathermy and homeostatic coblator which had made knot tying less popular.  This instrument can also be used to remove foreign body at tongue base area.

Homeostasis: The Paratonsillar Vein

Figure (left) shows a prominent left paratonsillar vein seen at the left tonsillar bed.  It was cauterized by using bipolar diathermy (right).  This is essential to avoid

the potential risk of reactionary bleeding.

Tonsillectomy by Using Coblator Device

 

Watch video of tonsillectomy @ YouTube

Watch another video of coblation tonsillectomy @ YouTube 

CO2-Laser Subcapsular Tonsillotomy

The PlasmaBlade

The PEAK PlasmaBlade showing the handle and its end-piece designed for tonsillectomy.

The close-up view of the end-piece tip.

The main console.

 

Watch video on PEAK PlasmaBlade Tonsillectomy @ YouTube

 

 

 

 Throat image just before the surgery.

Tonsils removed from a 7 year old child above by using the device shown.

Post-Tonsillectomy Bleeding

Bleeding occurring in a patient who had tonsillectomy performed 8 days earlier necessitating examination under anaesthesia for homeostasis.  The above figure showed formed blood clot occupying right tonsillar bed (BC) with active bleeding seen tracking down towards hypopharynx (X).  This secondary haemorrhage is usually caused by infection.  (U - uvula, T - tongue base, PPW - posterior pharyngeal wall) 

Bipolar cautery was used to diathermized the bleeder (arrow).  (PPF -palatopharyngeal fold, YS - Yankeur suction device)

 

Bleeding arrested after diathermy applied.  (PPF - palatopharyngeal fold, PGF - palatoglossal fold)

Adenoidectomy Techniques

       

                       Adenoid curette                                        Microdebrider

40 degrees curved adenoid microdebrider tip is shown facing towards the adenoids.  The aim of this this surgery to have the lymphoid tissue removed subtotally rather than complete.  This will reduce the bulk and "diseased" superfical tissue and allows further regression during adolescence years.

(A - adenoids, circle - posterior end of vomer).

Adenoidectomy: Intra-operative View

 

 

   

Before Surgery                                         After Surgery

 

Watch video of adenoidectomy @ MEDtube

Adenoidectomy by Using Peak Plasma Blade Device

Endoscopicview of the nasopharynx from right nasal cavity showing significant adenoids (A). (TT - torus tubarius, V - vomer)

 The tip end of the dedicated device with built-in suction channel and horizontal wired end (arrow) for cutting and homeostasis purposes.  (PPB - peak plasma blade device adenoidectomy tip)

Curettage of adenoids tissue.  A clean cut with an excellent homeostasis.  (PPB - peak plasma blade device adenoidectomy tip))

Post-operative endoscopic view at completion of surgery.

 

Peritonsillar Abscess: Incision & Drainage

 

Left peritonsillar abscess.  Severely inflamed, indurated andswollen soft palate with oedematous uvula and pushed medially off-midline.

 

 Pus extruded from tonsil crypts upon pressure.

 

 Abscess cavity reached upon incision and the pus then drained.

 Copious saline irrigation into the abscess cavity.

The view at completion of surgery.

Incision and Drainage of Peritonsillar Abscess (Quinsy)

 

This young female presented with severe sorethroat and can't swallow her saliva.  Her mouth openng was limited due to trismus from the infective inflammatory process.  There were no stridor or difficulty in breathing and her voice remains normal.  Endoscopic assessment revealed features of acute tonsillitis.  However, there was also fullness with induration of her soft palate on left side and the uvula became grossly oedematous.  Incision and drainage was performed under general grossly anaesthesia with copious pus under pressure seen.  Her pain dramatically reduced and she recovers swiftly with a course of antibiotic therapy.  (T - tonsil, U - uvula, L - larynx) 

Incision and Drainage of Tonsil Abscess with Tonsillotomy Biopsy

 

 

L - left, R - right, RT - right tonsil, LT - left tonsil,  U - uvula, star - pus collection

Surgery for Obstructive Sleep Apnoea (OSA)

1 - modified CAPSO before suture, 2 - partial uvula resection, 3 - tonsillectomy bed.(SP - soft palate) 

View after the modified CAPSO rectangle was sutured.

The appearance of healed surgical areas in a patient who underwent similar surgery as depicted above.  The OSA-related symptoms significantly improved and the patient regained good quality of life.

Tonsillectomy with Partial Uvulectomy

 Grade IV tonsillar hypertrophy with an elongated and hypertrophied uvula in a patient with obstructive sleep apnoea (AHI 46).

 (U - uvula, T - tonsil)

 

 

Endoscopic view of the patent's throat after tonsillectomy and partial uvula resection performed.  Snoring resolved after surgery and the patient feel fresher than previously.

Endoscopic-Assisted Rigid Oesophagoscopy: Removal of Impacted Food Material at Upper Oesophagus

How To Save The Facial Nerve During Parotid Salivary Gland Tumour Surgery

Parotidectomy Scar

 
Surgical incision as seen after wound exposure 24 hours after left superficial parotidectomy.  Redivac drain seen in place.
 
 
 
Fine surgical scar after right total parotidectomy performed 18 months earlier for adenoid cystic carcinoma. 

One Handed Surgical Knot

Flaps in Otolaryngology

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