1. Grommet insertion
2. Removal of lesion from pinna – wedge excision
3. Excision of preauricular sinus
4. Myringoplasty
5. Ossiculoplasty
1. Grommet insertion
clean ให้เห็น external auditory canal , เพื่อเห็น tympanic membrane
Myringotomy , ใช้ myringotomy knife , radial incision ที่ antero-inferior quandrant
middle ear effusion ใช้ 22 guage suction
yt – Grommet insertion
yt – Watch Me Insert a Grommet (part 1)
tympanic membrane
w – 耳膜破裂
耳膜破裂 耳膜穿孔 Ěrmó pòliè ěrmó chuānkǒng – ear drum , rupture , * perforate
概述 Gàishù – overview
耳膜破裂（鼓膜穿孔）是指隔开耳道与中耳的薄膜组织（耳膜）穿孔或撕裂。Gǔmó chuānkǒng * zhǐ gé kāi ěr dào yǔ zhōng ěr bómó zǔzhī * huò sī liè= tympanic membrane , perforate , refer , seperate ,ear canal , and , middle ear , membrane , tissue(structure) , or , tear
귀청 gwicheong – ear drum
w – 귀 건강 방치하면 진짜 ‘귀청’ 떨어진다?
w – ក្រដាសត្រចៀក – kradalstrachea ជំងឺរលាកត្រចៀករ៉ាំរ៉ៃ
ជំងឺរលាកត្រចៀករ៉ាំរ៉ៃ – chomgnu rorea tracheak ramrai = disease ,inflammatory , ear , chronic
នៅក្នុងកម្មវិធីសន្ទនាអំពីសុខភាពរបស់ពេទ្យយើង – nivknong komvithi santonea ampea sukapeab rabo pear yeang= in , program , broadcast , about, health , of , doctor , our
លោកវេជ្ជបណ្ឌិត ណេត សុផាត – lokvichearbandet net sukparb= Dr. , Net , Sukparb
ឯកទេសត្រចៀក ច្រមុះ និងបំពង់ក – ektesa trachea chromuk nuk bonpongkor = special , ears , nose , and , throat
នៅមន្ទីរពេទ្យព្រះអង្គឌួង – ner montriprae Pre Ang Duang= at , Hospital , Pre Ang Duang
insert Grommet ผ่านทาง myringotomy ใช้ crocodile forcepts , slightly curve needle
install drop เพื่อป้องกัน blockage of grommet lumen
ในคนไข้ down’s sydrome ตอนทำระหว่าง neck position , higher incidence of atlanto-axial instability
ระวัง ไม่ touching edges of myringotomy with suction tip เพราะอาจจะทำให้ perioperative bleeding and tympanosclerosis
2. Removal of lesion from pinna – wedge excision
3. Excision of preauricular sinus
4. Myringoplasty
inject xylocain hair-bearing skin from 12-6 o’clock
Surgical approach – 0.5-1 cm behind postauricular sulcus จาก inferior margin of external auditory meatus inferior ไปยัง level zygomatic arch superiorly
– postauricular muscles to temporalis fascia superiorly
– dissect ไปยัง posterior edge of bony external auditory canal
T-shape incision , elevate periosteum ,ไม่ tear periosteum or extenal auditory canal skin โดยเฉพาะ spine of Henle
เข้า ear canal , incision ผ่าน external auditory canal skin
Tip : ตอน incision – index finger อยู่ใน extenal auditory meatus
– กรณีไม่สามารถเห็น full extent perforation , เนื่องจาก tortous external auditory canal , สามารถทำ canalplasty , ดู mastoidectomy , canalplasty
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5. Ossiculoplasty