Tuesday, November 9, 2010


Assalamualaikum to all my friends n anyone who read this post.i hope all of u are in excellent conditions physically n spiritually as well.i would like to seek an apology from all u guys bcoz this week post for ENT is a little bit late..for this entry I want to bring up to you some important surgical knowledge we should know at least as a 4th year under graduate student n most importantly as a future doctors insyaAllah..it is the TRACHEOSTOMY.This surgery have NO CONTRAINDICATION.

Tracheostomy is a live saving technique and the most important approach in any obstruction of the airways.this technique is applied for almost all cases OF airways obstruction.

Definition: artificial opening of i cervical trachea.

Indication: 1.Lower airway obstruction

2.Upper airway obstruction

A. LOWER AIRWAY OBSTRUCTION.this patient facing one of these problem:


a.bilateral adductor paralysis

b.absent of cough reflex(protective function of the larynx).the patient cant expel the secretion.the secretion will flow back to I lung. Ie; the patient drowning in his own secretion.

Notes:larynx will protect the airway by closure of ventricle fold n vocal fold.this is the main mechanism of I larynx to protect the lower airways.

Patient with absent of cough reflex 1) comatous

2)paralysis of respiratory muscles

3)multiple ribs fracture

B.UPPER AIRWAY OBSTRUCTION ( trachea,larynx,supralaryngeal)

Tracheal obstruction; in the neck:enlarged goiter,malignant goiter

In the chest:retrosternal goiter,enlarged mediastinal glands

Laryngeal obstruction-congenital,traumatic,inflammation,neoplastic,etc..

Supralaryngeal-haryngeal carcinoma,very big nasopharyngeal fibroma.glossitis

*I just mention some examples

This is the least you must know about tracheostomy to perform the operation: Surgical anatomy

- The trachea is situated exactly a tthe midline,but maybe displaced to one side by an enlarged lobe of the thyroid or by cervical gland.

- Trachea more superficial at the upper end.it pass downward n backward.so at the manubrium it is deep.

- About 7-8 cartilaginous rings

- In child mote the following’; neck is shorter,larynx is higher,trachea is more superficial, the thyroid isthmus usually cover 3rd n 4th rings

Types of tracheostomy:

1.HIGH: in emergency n malignancy

2.Low: tracheal stenosis/tumor/multiple papillomatosis in children.

3.MID:mostly tracheostomy done in mid position.

Every doctor should know how to do tracheostomy.We maybe found in a situation desperately calling for it.for instance a patient in severe stridor n about to suffocate..you can read further in the text book from page 244 till 249.I think it is not neccesarry for me to write all the contents..what important is, I just want to highlight ” how important it is”.

This is a true story from my own collection. last week I go to the OT n dr HAZEM EMANN( the one who teach us tracheostomy) ask about it,I answer nothing except silentness..3 others doctors are there n just looking at me. Then dr said, “ I feel very sad bcoz I learn u nothing,you can leave everything on this chapter except tracheostomy.” .At that time I fell like the whole world is falling on me. OH HO HO HO HO..terrible,terrible,terrible..

B4 I finish this entry..i want to share something ..something that make us wiser person if we understand..something that make the world really a heaven..something that cheer up our heart..something that every muslims should understand..

4 hal yg membuat hidup menjadi sulit,perasaan menjadi tertekan dan dada terasa sempit:

1.Tidak menerima qadha’ dan qadar

2.membuat maksiat tanpa disertai dgn taubat

3.irihati dan hasad dengki

4.berpaling dari Allah.Naudzubillah..


Selamat berpuasa & menyambut AidilAdha :)

collection of collection

Collections that collected during lecture..if u find anything not compatible with what u wrote or what dr said,just tell me. will not take it personally..sharing is caring.(arrangement is in order of “rojak style) :)
True membrane(3)
-strep pharyngitis
Scarlet fever
Acute tonsillitis
False membrane(5)
Vincent’s angina
Agranulocytosis n acute leukemia
Chronic hyperthrophic tonsillitis ( the inflamation will show the same color with surrounding mucosa).have 5 types.how to differentiate it clinically:
-follicular-red +pus( appear as yellow spot)
-parenchymatous-red + enlarged
-membranous-red membrane( the membrane make the appearance like coalesce together)
Snoring-dt upper supralaryngeal obstruction during sleeping
Stretor-same with snoring but during awake.bcoz theI soft palate closed I airway
Stridor-difficult noisy breathing dt laryngeal cause( ins) n upper trachea n subglotic(exp)
Wheeze_noisy breathing dt lower airway obstruction(exp) eg bronchi,bronchiolect
Angiofibroma; characteristic-recurrent severe epistaxis
-exclusive in male,if female get this dse,check the chromosom
-teen agers dse
-origin at the sphenopalatine foramen n get bl supply from
maxillary a.
Pulsating ear discharge:
Extradural abcess
Pulsating tumor in ME
Small or high perforation(pus under tension n in adequate drainage)
Acute OM on top of chronic OM
False –ve fistula test(it is false bcoz the fistula is actually there but it is negative when we do the test).the patient will not have nystagmus..subtopic otitic labyrinthis.
Dead labyrinth
Very small fistula
Massive cholesteatoma( closing the fistula)
Obstructed EAC by wax
Vertigo without SNHL
Benign paroxysmal positional vertigo(BPPV)
Vestibular neuritis
SNHL without vertigo
Congenital vertigo(vertigo not develop untLi after the 1st year of life)
Senile detoriation(presbycusis)
Cochlear toxic drug
Noise trauma(juz effect the cochlea,the vestibular is preserve)
**short note about SNHL
Sudden SNHL loss associated with viral or vascular origin can be treat medically.
Little patient with SNHL can become normal again by medical treatment.There is no surgical correction of SNHL ,just rehabilitation.SNHL only rehabilitated by hearing aid(HA) eg:cochlear implant.
Attention! This 2 items depend only the clinical picture of the dse.there is no test or radiological evaluation for this 2 dse:
1Patient experience vertigo for seconds on specific condition. -BPPV
2) Vertigo last for days/weeks.not related to head position but vertigo will increase with the increased of head movement-à vestibular neuritis
Bell’s phenomena
Rolling up of the globe to be protected by the upper lid(in case of facial nerve paralysia)
-dahsyatkan potensi dirimu raih prestasi luar biasa-