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)
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..
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.
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.
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.
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.
The different types of distal attachment.
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.
Panoramic view of oropharynx at completion of peak plasma tonsillectomy. (L - left, R - right, U - uvula, TP - throat pack, TB - tonsil bed)
Close-up view of right tonsil bed.
Close-up view of left tonsil bed.
U - uvula, (+) - oedematous uvula tip, T - tongue, SP - soft palate, 1 - tonsillar bed post-tonsillectomy
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)
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).
Before Surgery After Surgery
Watch video of adenoidectomy @ MEDtube
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.
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.
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)
Excision of focal left tonsil abscess with its immediate surrounding tissue. (Above - pre-excision, below - immediate post excision]
L - left, R - right, RT - right tonsil, LT - left tonsil, U - uvula, star - pus collection
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.
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.