Ear surgery
Ear surgery is performed in acute purulent inflammation of the mastoid process - mastoid operation( MO), chronic purulent otitis media( epitimpanitis) - radical surgery( RO);internal complications( sigmoid sinus thrombosis, epidural abscess, brain abscess, meningitis);some types of hearing loss( otosclerosis), Cicatricial changes in the tympanic cavity.
Mastoid operation - opening of the mastoid process - is performed with its purulent inflammation.
The instrument table is installed either between the surgeon and the assistant, or over the thoracic part of the patient's torso, provided that he does not obstruct the patient's breathing. Tools should be placed on the table in the order in which they will be used during the operation.
The following tools are needed for MO: scalpel pointed, rammer, Voyachek chisel flat, Voyachek chisel gutters: large, medium and small( antral), broad gouge, medium chisel, 2 flat chisels( 1 and 0.5 cm), chiselnarrow, earwax forceps, 2 surgical tweezers, earplugs tweezers, 2 bone forceps, Cooper scissors, 2 bone spoons: medium and small, hammer, self-retaining self-retaining ear, 3 ear funnels of different sizes, bellied Voyatcha probe, Voyachek's ear needle, 5 hemostatic clampsin 5 clamps laundry 5 ml syringe, a rubber balloon elektrootsasyvatel, needle holder.
The patient needs to be laid on his back, his head turned towards the unoperated ear. The face is covered with gauze, which should not impede breathing and limit the possibility of free observation of the patient's face. This is an important point, because at certain stages of surgery, the operating nurse, at the request of the surgeon, must report whether there are any contractions in the facial muscles-the reaction of the facial nerve to the manipulation of the surgeon near him. During the operation, the nurse gives the necessary tools, gauze napkins, balls, ears, or cotton balls, warmed to body temperature saline in a rubber balloon for washing the wound, includes an apparatus for suctioning from a blood wound or rinsing fluid that is connected to the electrical network before the operation begins, as well as a diathermic apparatus, if a diathermic current is used to stop bleeding from small vessels. At the end of the operation, if the wound is left open, the sister gives the petroleum-soaked turuns to cover the edges of the wound, and then Vaseline diluted with vaseline oil to lubricate the skin around the wound, gauze balls, cotton wool for the "columnar" dressing and bandage.
Columnal bandage, proposed by Professor VP.Voyachek, is superimposed as follows: on the wound in the behind-eye area, sterile gauze balls are placed in several layers, which are then covered with cotton and all together fixed with a bandage. The bandage is carried from the occipital area over the headband over the forehead, from the forehead above the auricle of the opposite side to the neck, then under the chin and up behind the ear from the healthy side, through the crown, down through the bandage, around the neck to the starting position, and then the bandage repeats 1-2 times. Thus, the movement of the bandage resembles a figure eight: the vertical passages of the bandage through the bandage are fixed by oblique courses from the occipital area to the forehead. Thanks to the alternation of the bandages, the bandage turns out to be strong, unbreakable.