Otorhinolaryngology

otorhinolaryngology iran

Otorhinolaryngology

Otorhinolaryngology /tˌrnˌlærənˈɡɒləi/ (also called otolaryngology and otolaryngologyhead and neck surgery) is a surgical subspecialty within medicine that deals with conditions of the ear, nose, and throat (ENT) and related structures of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, ENT doctors, ENT surgeons, or head and neck surgeons. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, and for the surgical management of cancers and benign tumors of the head and neck.

Etymology

The term is a combination of New Latin combining forms (oto- + rhino- + laryngo- + -logy) derived from four Ancient Greek words: οὖς ous (gen.: ὠτός otos), "ear", ῥίςrhis, "nose", λάρυγξ larynx, "larynx" and -λογία logia, "study" (cf. Greek ωτορινολαρυγγολόγος, "otorhinolaryngologist").

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Training

Otorhinolaryngologists are physicians (MD, DO, MBBS, MBChB, etc.) who, in the United States, complete at least five years of surgical residency training. This is composed of six months of general surgical training and four and a half years in specialist surgery. In Canada and the United States, practitioners complete a five-year residency training after medical school.

Following residency training, some otolaryngologist-head & neck surgeons complete an advanced sub-specialty fellowship, where training can be one to two years in duration. In the United States and Canada, otorhinolaryngology is one of the most competitive specialties in medicine in which to obtain a residency position following medical school.

In the United Kingdom entrance to otorhinolaryngology higher surgical training is highly competitive and involves a rigorous national selection process. The training programme consists of 6 years of higher surgical training after which trainees frequently undertake fellowships in a sub-speciality prior to becoming a consultant.

Sub-specialties

Head and Neck Oncologic SurgeryFacial plastic and reconstructive surgery*OtologyNeurotology*Rhinology and Sinus SurgeryLaryngology and Voice DisordersPediatric Otorhinolaryngology*Sleep Medicine*
Surgical oncologyFacial cosmetic surgeryEarMiddle and inner earSinusitisVoice disordersVelopalatine insufficiencySleep disorders
MicrovascularreconstructionMaxillofacial surgeryHearingTemporal boneAllergyPhono-surgeryCleft lip and palateSleep apnea surgery
Endocrine surgeryTraumatic reconstructionBalanceSkull base surgeryAnterior skull baseSwallowing disordersAirwaySleep investigations
Endoscopic SurgeryCraniofacial surgery DizzinessApnea and snoring Vascular malformations
   Cochlear implant/BAHA  Cochlear implant/BAHA

Topics

Free Muscle Transfer

In this type of surgery, a surgeon harvests a muscle from the back or from the abdominal region for reconstruction of the skull or the cranial vault. Latissimus is another word for back in the medical field as well as rectus abdominis which is your abdominal area. The muscle is sometimes useful for sealing off the central nervous system in ones body and allowing it to heal the complex wounds. A study was down with five patients who underwent the free muscle transfer for a smile reconstruction. Two of the five patients prior to this surgery had failed their first free muscle transfer.  The next two patients had vascular anomalies and one had a previous distal ligation of the facial vessels. In three of the cases, they used a submental vein, and in all the cases they used a donor submental artery. “In all 5 the gracilis vascular pedicle comprised a muscular branch of the profunda femoris together with its venae comitantes, with the artery and vein ranging in size from 1.0 to 1.5 mm and 2.0 to 2.5 mm, respectively. The submental artery provided an excellent size match in all cases, ranging in size from 1.0 to 1.5 mm”(Faltaous AA, Yetman RJ). The first patient was a 45 year old woman who developed a dense flaccid right facial paralysis at the age of 33.  The second patient was an 8 year old girl who had developed dense flaccid left facial paralysis after a laser treatment at four weeks for, “bilateral infantile segmental hemangiomas in the distribution of the mandibular division of the trigeminal nerve (V3). “(volume 38, issue 10). The third case was a 19 year old male who had developed a segmental right facial paralysis after a excision of a infantile parotid hemangioma at the age of 2. The fourth case was a 20 year old woman who had developed dense flaccid right facial paralysis after a biopsy of a pontomedullary junction tumor at the age of 2. Lastly, case five was a 19 year old woman who had incomplete flaccid left facial palsy.

Free Bone Transfer

Bone defects are often the most difficult reconstructions as it requires precise alignment. Bone transfer is commonly used for the mandibular reconstruction, but it now allows surgeons to use it for the midface and the orbito maxillary. If for some reason the fibula is not available for transfer, another option the team may go is using the back rib free flap. This allows the transfer to give the bone volume for the patients. The earliest first bone transfer was done all the way back in 2000 BCE when the Peruvian priest implanted a metallic plate to reconstruct the contour defects of the religious trephination. In 1668, a man by the name of Jobs van Meekeren reported the use of dog bone grafts to reconstruct the calvarium in the soldier. “…the ideal of the future: the insertion of a piece of living bone which will exactly fill the gap and will continue to live without absorption.”(The Epitome of Medicine).

Free Skin and Free Fat Transfer

The radial forearm is the most commonly dominant use of flap to be used to coverage up damages. Today, the anterolateral thigh flap is being used on patients for the head and the neck because it has an ideal match for the site and it is easy to harvest. If a surgeon chose to remove/harvest the tissue, safe places are the following; skin, skin and fat, fat and fascia, or just the fascia by itself.

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Microvascular reconstruction repair

Microvascular reconstruction repair is a common operation that is done on patients who see a Otorhinolaryngologist. Microvascular reconstruction repair is a surgical procedure that involves moving a composite piece of tissue from the patient's body and moves it to the head and or neck. Microvascular head and neck reconstruction is used to treat head and neck cancers, including those of the larynx and pharynx, oral cavity, salivary glands, jaws, calvarium, sinuses, tongue and skin.The tissue that is most common moved during this procedure is from the arms, legs, back, and can come from the skin, bone, fat, and or muscle. When doing this procedure, the decision on which is moved is determined on the reconstructive needs. Transfer of the tissue to the head and neck allows surgeons to rebuild the patient's jaw, optimize tongue function, and reconstruct the throat. When the pieces of tissue are moved, they require their own blood supply for a chance of survival in their new location. After the surgery is completed, the blood vessels that feed the tissue transplant are reconnected to new blood vessels in the neck. These blood vessels are typically no more than 1 to 3 millimeters in diameter which means these connections need to be made with a microscope which is why this procedure is called “microvascular surgery.”

Head and neck oncology

  • Squamous cell carcinoma of the oral cavity, pharynx and larynx
  • Oral cancer
  • Skin cancer of the head & neck
  • Thyroid cancer
  • Endocrine surgery of the head and neck (thyroidectomy, parathyroidectomy)
  • Microvascular free flap reconstruction
  • Skull base surgery
  • Salivary gland cancer

Otology and neurotology

  • Dizziness
    • BPPV – benign paroxysmal positional vertigo
    • Labyrinthitis/Vestibular neuronitis
    • Ménière's disease/Endolymphatic hydrops
    • Perilymphatic fistula
    • Acoustic neuroma
  • Hearing loss
  • Mastoiditis
  • Otitis externa – outer ear or ear canal inflammation
  • Otitis media – middle ear inflammation
  • Perforated eardrum (hole in the eardrum due to infection, trauma, explosion or loud noise)
  • Ear surgery

Rhinology

Rhinology includes nasal dysfunction and sinus diseases.

  • Nasal obstruction
  • Nasal septum deviation
  • Sinusitis – acute, chronic
  • Environmental allergies
  • Rhinitis
  • Pituitary tumor
  • Empty nose syndrome
  • Severe or recurrent epistaxis

Pediatric otorhinolaryngology

  • Adenoidectomy
  • Caustic ingestion
  • Cricotracheal resection
  • Decannulation
  • Laryngomalacia
  • Laryngotracheal reconstruction
  • Myringotomy and tubes
  • Obstructive sleep apnea – pediatric
  • Tonsillectomy

Laryngology

  • Dysphonia/hoarseness
    • Laryngitis
    • Reinke's edema
    • Vocal cord nodules and polyps
  • Spasmodic dysphonia
  • Tracheostomy
  • Cancer of the larynx
  • Vocology – science and practice of voice habilitation

Facial plastic and reconstructive surgery

Facial Plastic and Reconstructive Surgery is a one-year fellowship open to otorhinolaryngologists and plastic surgeons who wish to specialize in the aesthetic and reconstructive surgery of the head, face, and neck.

  • Rhinoplasty and septoplasty
  • Facelift (rhytidectomy)
  • Browlift
  • Blepharoplasty
  • Otoplasty
  • Genioplasty
  • Injectable cosmetic treatments
  • Trauma to the face
    • Nasal bone fracture
    • Mandible fracture
    • Orbital fracture
    • Frontal sinus fracture
    • Complex lacerations and soft tissue damage
  • Skin cancer (e.g. Basal Cell Carcinoma)

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