Instruments part 2
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This document describes various instruments used in otorhinolaryngology. It discusses nasal speculums like the Thudicum and Killian speculums used to examine the nose. Indirect laryngoscopy mirrors of varying sizes are described for examining the larynx. Other instruments mentioned include the Higginson syringe for nasal irrigation, osteotomes and chisels for bone cutting, curettes for bone removal, and various aural speculums for examining the ear canal.
Instruments part 2
- 2. Compiled by: Sauradeep Dey ( deysauradeep@gmail.com ) 2 PART 1
- 3. Thudicum Nasal Speculum3 • self-retaining nasal speculum • USES: a. Diagnostic: Anterior rhinoscopy— nasal septum, Little’s area, lateral wall of nose, nasal cavity b. Therapeutic: removal of foreign bodies, antral wash, nasal packing, surgical procedures inside the nose. • Held over the hooked index finger of the non-dominant hand. The blades are then closed by pressing between middle and ring finger.
- 4. Killian Long Bladed Nasal Speculum 4 Uses: a. Diagnostic: Anterior rhinoscopy—nasal septum, Little’s area, lateral wall of nose, nasal cavity. b. Therapeutic: • Removal of foreign bodies • nasal packing • surgical procedures inside the nose like polypectomy, SMR, septoplasty, etc • This is a self-retaining nasal speculum • blades of different sizes. • The distance between the blades can be adjusted and fixed with a screw.
- 5. St. Clair Thompson posterior rhinoscopy mirror5 • This instrument has a bayonet shaped handle so that the examiner’s hand does not block his vision. • The mirror is available in sizes of 0 to 5 and should be of an appropriate size so as to pass behind soft palate and reflect sufficient light for the image to be seen. • This is a plain mirror and does not magnify the image. USES • Posterior rhinoscopy • to examine the postnasal space after adenoidectomy to look for remnants if any.
- 6. Indirect laryngoscopy mirror 6 This instrument has a handle, shaft and a plain mirror at an angle. The focal length of this mirror is at infinity. The mirror is available in various sizes ranging from 8 mm to 30 mm. USES a. For examination of tongue base, valleculae, glossoepiglottic fold, pharyngoepiglottic fold, arytenoids, aryepiglottic folds, ventricular bands, vocal cords, interarytenoid region, pyriform fossae and posterior pharyngeal wall. These regions can be examined for any foreign body, inflammatory, noninflammatory, traumatic or neoplastic lesions. b. To remove small foreign bodies like fish bone. c. To remove tissue for histopathological examination.
- 7. Indirect laryngoscopy Structures not seen in this procedure: • Post-cricoid region • Apex of pyriform fossa • Ventricles • Undersurface of vocal cords and adjoining subglottic region • Laryngeal surface of epiglottis. Pitfalls of indirect laryngoscopic examination: • There is anterior and posterior reversal of structures in the mirror image • Overhanging of epiglottis may obscure vision • The anterior commissure is poorly visualized • Depth perception is poor • The procedure is difficult in children • The tongue may rise on phonation and may obscure the view of larynx • The procedure is difficult in a person with short neck • The vocal cords appear short and flat in the mirror • The vocal cords appear white due to the reflection of a greater amount of light to the mirror from the vocal cords than the rest of the larynx. 7
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- 9. Higginson Syringe 9 USES a. Antral wash b. Nasal douching in atrophic rhinitis. It has a bulb with red rubber tubing on either side. One end of the rubber tubing ends in a valve and the other ends in a nozzle. The valve allows only inflow of water into the bulb. The valve end is kept in water and the nozzle end is connected to the antral wash cannula. The capacity of the bulb is about 50 ml and the syringe is made up of red rubber material.
- 10. Asch septal forceps Walsham forceps 10
- 11. Heymann turbinectomy scissor11 This instrument is bent obtusely at the centre and has narrow blades with blunt tip and works in the vertical plane. Uses: a. Partial or total turbinectomy b. Can be used to cut the cartilage in septal surgeries.
- 12. Nasal chisel Osteotome 12 Uses: a. For external osteotomy in rhinoplasty b. For osteotomy cuts in maxillectomy, mandibulectomy. Used to make bony cuts during lateral rhinotomy, maxillectomy, mandibulotomy, etc.
- 13. Freer double ended mucoperichondrial elevator 13 USES a. To elevate mucoperichondrial and periosteal flap in septal surgeries b. For displacement of inferior turbinate in antrostomy operation c. For elevating canal skin and cartilage perichondrium in mastoid surgeries d. For elevation of mucosa in Caldwell-Luc operation e. To spread and tease temporalis fascia graft f. To perform uncinectomy.
- 14. Ballenger swivel knife14 • This is a knife that can rotate 360 degrees within its two prongs • This instrument is used in submucous resection of septum • harvest cartilage for rhinoplasty and tympanoplasty.
- 15. Jenkin mastoid gouge 15 A gouge is an instrument with a curved rounded tip that has smooth beveling. Hence, it cuts bone in a circular pattern. It is held at an acute angle to the bone for cutting it and a mallet is used for hitting on it. The gouge has been replaced by the electrical drill in the present day. USES a. Remove hard bone during mastoidectomy b. Caldwell-Luc operation c. Excision of exostosis in external auditory canal.
- 16. Heath mallet 16 • This instrument appears like a hammer and is used along with a gouge, chisel or osteotome. • The gouge is to be hit by a mallet with movement at the wrist during septal surgery.
- 17. Lempert mastoid curette 17 • Used to curette chunks of bone from mastoid and ear canal during ear surgeries like • Tympanoplasty • mastoid exploration • stapedotomy. • Can also be used to remove granulation tissue and cholesteatoma.
- 18. Aural speculum 18 Uses: Examination of the external ear canal and tympanic membrane Removal of wax, foreign body, otomycosis or ear discharge In operative procedures like myringotomy, myringoplasty, stapedotomy, stapedectomy For transcanal injections.
- 19. HOLMGREN • adjustable aural speculum this is a self-retaining adjustable aural speculum with a screw. • used for examination of ear and ear surgeries. HARTMANN AURAL SPECULUM: • This is a funnel shaped speculum that has no slit on the body. • The broader end is thickened for better grip. 19
- 20. ROSEN AURAL SPECULUM • This is an aural speculum with an incomplete slit on its body. • The slit is useful for injections on the external canal wall with the speculum in place. SHEA AURAL SPECULUM: • This aural speculum resembles Hartmann aural speculum. • However, the narrow end of this speculum is beveled. 20
- 21. 21 Tumarkin aural speculum: This aural speculum has a complete split on its body to facilitate intra-aural injections into the external canal.
- 22. Ear vectis with cerumen spud 22 • This instrument is used to remove wax and foreign bodies from the ear. • One end of this instrument has a ring vectis while the other end has a blunt curette.