Atlas of Instruments in Otolaryngology - Bhat, K. Vikram (SRG)
Atlas of Instruments in Otolaryngology - Bhat, K. Vikram (SRG)
Atlas of Instruments in Otolaryngology - Bhat, K. Vikram (SRG)
Otolaryngology
Disclaimer
Atlas of Instruments in
Otolaryngology
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Atlas of Instruments in Otolaryngology, Head and Neck Surgery
First Edition: 2012
ISBN978-93-5025-713-5
Printed at
Dedicated to
Our teachers
and
parents
Foreword
Preface
Acknowledgments
xii
Contents
1. Instruments in Ear 1
General Ear Instruments
1. Jobson-Horne ear probe with ring curette 1
2. Ear vectis with cerumen spud 2
3. Hartmann aural forceps 3
4. Troeltsch aural forceps (Wilde) 3
5. Tilley aural forceps 4
6. Lucae curved aural forceps 4
7. Tuning fork 5
8. Siegel pneumatic speculum with bulb 7
9. Eustachian tube catheter 7
10. Politzer apparatus 10
11. Otoscope 11
12. Pneumatic attachment for otoscope 12
13. Adult rigid otoendoscope 12
14. Simpson aural syringe 12
15. Barany noise box 14
16. Aural speculum 15
17. Frenzel nystagmus spectacles with inbuilt
battery handle 17
Hearing Devices
18. Body level hearing aid 18
19. Behind the ear hearing aid 18
20. In the ear hearing aid 19
21. Receiver in the canal (RIC) hearing aid 20
18
Myringotomy 26
28. Politzer myringotome 26
29. Lucae micro ear knife 26
30. Grommet 27
31. Grommet introducer 31
Mastoidectomy and tympanoplasty
32. Hanging motor drill 32
33. Handpiece for hanging motor drill 32
34. Micromotor unit for drilling 33
35. Micromotor drill handpiece 34
36. Contrangle handpiece 34
37. Verhoeven microsuction tip 35
38. Ear microsuction tip adapter 35
39. Farabeuf mastoid periosteal elevator 36
40. Mollison self-retaining mastoid retractor
(44 prongs) 37
41. Plester self-retaining mastoid retractor 1
(33 prongs) 37
42. Plester mastoid retractor 2 (22 prongs) 38
43. Weitlaner (34 prongs) mastoid retractor 1 39
44. Weitlaner mastoid retractor 2 (23 prongs) 39
45. Jansen mastoid retractor (33 prongs) 40
46. Wullstein self-retaining mastoid retractor
(33 prongs) 40
32
Contents
xv
76.
77.
78.
79.
80.
81.
82.
Rosen-curved microcurette 58
Zollner micro ear instrument set 59
Schuknecht roller knife 59
Trautmann micro ear knife 60
Glegg aural snare 61
Staecke guide and protector 61
Fisch glomus retractor 62
Ossicular Implants
83. Total ossicular replacement prosthesis (TORP) 63
84. Partial ossicular replacement prosthesis (PORP) 63
85. Models of ossicular replacement
prosthesistitanium 64
63
Stapes Instruments
86. Fisch titanium stapes piston 65
87. Causse teflon stapes piston 65
88. McGee wire stapes prosthesis 65
89. Piston holding forceps 65
90. Schuknecht wire bending die 66
91. Shea stapedectomy piston measuring rod
(Three markers) 67
92. Stapes piston measuring jig 68
93. House stapedectomy piston measuring rod 68
94. Stapedotomy perforator bur straight 69
95. Larkin hand perforator bur 69
96. McGee stapes piston crimper 70
97. Fisch crurotomy scissors 70
98. Crurotomy knife 70
65
72
xvii
Contents
77
82
90
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
Contents
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
xix
xx
82.
83.
84.
85.
86.
87.
88.
Rhinoplasty 134
89. Fomon alar retractor for rhinoplasty 134
90. Cottle alar retractor and protector 134
91. Kilner alar retractor for rhinoplasty 1 135
92. Kilner retractor for rhinoplasty 2 135
93. Mcindoe nasal fine wound retractor 135
94. Cottle four pronged alar retractor 136
95. Aufricht nasal retractor for rhinoplasty 136
96. Cottle columellar clamp 137
97. Walter rhinoplasty scissors 1 138
98. Walter rhinoplasty scissors 2 138
99. Aufricht coarse rasp for rhinoplasty 139
100. Joseph fine rasp for rhinoplasty 140
101. Masing chisel for osteotomy 140
102. Nasal chisel 141
103. Straight chisels 141
104. Freer chisel 141
105. Jansen chisel 142
106. Osteotome 142
107. Castroviejo rhinoplasty measuring caliper 143
108. Curved raspatory for rhinoplasty 143
109. William Watson curved coarse rasp 144
110. Joseph nasal saw 144
111. Cartilage crusher 144
112. Joseph curved rhinoplasty knife 146
xxi
Contents
148
3. Instruments in Throat
156
Adenotonsillectomy Instruments
156
1. Boyle Davis mouth gag with tongue blade 156
2. Doughty tongue blade 156
3. Russel Davis tongue blade 158
4. Magauren plate 158
5. Draffin bipods 158
6. St Clair Thompson adenoid curette with cage 159
7. Beckmann adenoid curette without cage 160
8. Adenoid through cutting forceps 160
9. Laforce adenotome 161
10. St Clair Thompson adenoid tag forceps 161
11. Dennis Browne tonsil holding forceps 161
12. Muck forceps 162
13. Colver tonsillar vulsellum forceps 163
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Miscellaneous Instruments
29. Lac tongue depressor 173
30. St Clair Thompson quinsy forceps 173
31. Indirect laryngoscopy mirror 174
32. Collin tongue holding forceps 176
33. Guiding probe 177
34. Yankauer nasopharyngoscope 177
35. Ferguson Ackland mouth gag 178
36. Heister mouth gag 178
37. Dingmann mouth gag 178
38. Doyen mouth gag 179
39. Wire cutting scissors 180
40. Cleft palate elevator 180
173
182
Contents
xxiii
22.
23.
24.
25.
26.
27.
28.
29.
Microlaryngoscopy 210
30. Kleinsasser suspension laryngoscope for
microlaryngeal surgery (MLS) 210
31. Kleinsasser anterior commissure
operating laryngoscope 211
32. Distending operating laryngoscope 212
33. Riecker chest piece and Jack for MLS 212
34. Detachable microlaryngeal instruments 212
35. Laryngeal straight cupped forceps for MLS 214
36. Laryngeal scissors for MLS 214
37. Lindholm vocal cord and false cord retractor 215
38. Laryngeal needle for injection 216
39. A. Bruning laryngeal syringe 216
B. High pressure handle 216
Thyroplasty 218
40. Laryngeal calipers for thyroplasty 218
41. Male laryngeal window marker 218
42. Female laryngeal window marker 218
43. Round mucoperichondrial elevator for
thyroplasty 220
44. Thyroplasty mucoperichondrial elevator sharp 220
Contents
xxv
240
240
xxvii
Contents
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
No 11 blade 259
No 15 blade 260
No 12 blade 260
Humby knife (skin graft blade holder
with handle) 260
Down blade for skin grafting 261
Halsted mosquito forceps 262
Lister sinus forceps 262
Hemostatic artery forceps 262
Mayo towel clip 264
Rampley sponge holding forceps 264
Cheatle forceps 265
266
Appendix 269
Instruments with Common Scientist Names in Ear
1. House 269
2. Fisch 269
3. Shea 269
4. Lempert 269
5. Cawthorne 270
6. Plester 270
7. Rosen 270
8. Schuknecht 270
9. McGee 270
10. Wullstein 270
11. Lucae 271
12. Weitlaner 271
13. Politzer 271
14. Hartmann 271
269
275
Index
277
Instruments in Ear
Instruments in Ear
Instruments in Ear
c. Stem
d. Base.
Common types:
a. Hartmann
b. Gardiner tuning fork.
The tuning fork is struck at the junction of upper one-third and
lower two-third of the prongs. The vibrating tuning fork with the
prongs in the acoustic axis is placed at a distance of 2.5 cm from the
auricle for air conduction. The vibrating tuning fork is then placed
with the base touching the mastoid process for bone conduction. It
is available in various frequencies128, 256, 512 and 1024. The 512
Hz tuning fork is commonly used for the following reasons.
a. It is present in the mid speech frequency range
b. Overtones are minimal
c. Sound is more auditory than tactile in nature
d. Tone decay is optimal.
Uses of the tuning fork:
a. To detect the type of hearing loss
b. To make an approximate estimate of the degree of hearing
loss.
Instruments in Ear
Instruments in Ear
Instruments in Ear
Parts:
1. Rubber bulb
2. Nozzle
3. Rubber tube
4. Nose piece
The rubber tube is connected to the nozzle and the nosepiece is
fixed inside the nasal cavity on the side of the Eustachian tube to
be tested. The other nostril is closed to prevent air leak. The rubber
bulb is now pressed and the patient is asked to swallow. By means of
an auscultation tube connecting the patients ear under test to the
examiners ear, a hissing sound is heard if the Eustachian tube is
patent. This test can also be used to artificially ventilate the middle ear.
Adam Politzer (18351913) was a prolific author and teacher. His name is
associated with Politzer bag, cone of light, speculum and the test for unilateral
deafness. He introduced one of the first mechanical audiometers. He correctly
described otosclerosis as the disease of labyrinthine capsule, rather than being
secondary to chronic middle ear catarrh as was thought. In 1896, he first
published atlas of photos of tympanic membrane by illumination.
11. Otoscope (Fig. 1.11)
It is a hand-held battery operated instrument used to visualize
the external auditory canal, tympanic membrane and the middle
11
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13
Uses:
a. To remove softened wax
b. To remove nonhygroscopic foreign body and small hygroscopic foreign bodies.
Contraindications:
a. Perforated tympanic membrane
b. Otitis externa
c. CSF otorrhea
d. Large hygroscopic foreign body
e. Atrophic or thinned out tympanic membrane.
Complications:
a. Tympanic membrane rupture
b. Vasovagal attack
c. Injury to the external auditory canal
d. Vertigo due to stimulation of labyrinth.
15. Barany noise box (Fig. 1.15)
This is a device used to produce the noise and mask the non test
ear during tuning fork test.
Robert Barany (1876-1936) in 1906, invented the chair for use during vestibular testing. In 1914, he received Nobel prize for clarification of
physiology and pathology of vestibular apparatus. He established caloric
testing as diagnostic tool and also new criteria for diagnosis of labyrinthitis.
Instruments in Ear
15
Uses:
a. Examination of the external ear canal and tympanic
membrane
b. Removal of wax, foreign body, otomycosis or ear discharge
c. In operative procedures like myringotomy, myringoplasty,
stapedotomy, stapedectomy
d. For transcanal injections.
There are several types of aural speculum.
a. Holmgren adjustable aural speculum
This is a self-retaining adjustable aural speculum with a
screw. Used for examination of ear and ear surgeries.
b. Hartmann aural speculum
This is a funnel shaped speculum that has no slit on the
body. The broader end is thickened for better grip.
c. 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.
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17
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19
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21
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23
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25
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27
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29
tube in position on the tympanic membrane while reducing chances of early extrusion. The soft flanges of the
ventilation tube permit easy removal at any time.
c. Shepard grommet
This is also a fluoroplastic grommet where one flange is
thicker than the other. The thicker flange has to lie on the
outer lateral surface of the tympanic membrane. This is
relatively easy for insertion and is a short-term grommet.
d. Shah type ventilation tube
This grommet has a shoehorn type tab on its inner flange
that facilitates insertion in small incisions and resists
extrusion. The thicker flange lies on the outer surface of
the tympanic membrane.
e. Baxter angled grommet
This is a fluoroplastic grommet that is funnel shaped.
There is a thin flange on the medial end and beveling on
the lateral end.
f. Bobbin grommet
This is also a fluoroplastic grommet. The lateral end is bell
shaped while the medial end has a thin flange. The bell
shape may improve ventilation and view through the lumen.
Instruments in Ear
31
Instruments in Ear
33
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35
Instruments in Ear
37
Instruments in Ear
39
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41
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43
the drilling field with normal saline. This instrument is very useful
in temporal bone dissection laboratory.
52. Lempert mastoid suction tube (Fig. 1.52)
This is a suction tip used in ear surgeries. It has a thumb rest with a
vent to control the force of the suction. Available in various sizes.
53. Cutting bur (Fig. 1.53)
This is a bur tip with grooves and sipes on its body and is available in various sizes. Fewer the sipes, larger is the chunk of bone
removed during drilling. Here, the cutting surface is not the tip
45
Instruments in Ear
of the bur but the side. The largest bur is used initially to perform mastoidectomy. The bur tip might be made up of steel,
tungsten carbide or titanium. The diameter of the cutting bur
and the diamond bur varies from 0.5 mm to 7 mm and the length
varies from 45 mm to 70 mm.
54. Diamond bur (Fig. 1.54)
Made up of steel, tungsten carbide or titanium and is available
in various sizes. There are two types of diamond burs. The one
which has an irregular, coarse surface is a cutting or coarse diamond
bur. The one with a regular, rough surface is a polishing fine
diamond bur. Both of them do not have sipes or grooves on
the surface. Hence, the polishing bur removes bone much more
slowly and smoothly during drilling. Therefore, it is preferred for
use on delicate structures like the facial nerve and sigmoid sinus.
It is also used for polishing the surface of many structures in the
middle ear and mastoid after drilling with a cutting bur during
mastoidectomy. In this process of polishing it can stop bleeding
from bony surfaces by clogging the vessels with bone dust.
55. Jenkin mastoid gouge (Fig. 1.55)
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 hammer 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.
GJ Jenkins (18741939) taught anatomy and then otology at Kings
College Hospital, London. He was a pioneer in the surgical treatment of
meningitis. He attempted fenestration surgery for otosclerosis and opened
horizontal canal.
56. House graft press forceps (Fig. 1.56)
Used to press and shape harvested cartilage, vein graft or fascia
before using for ossiculoplasty or stapedectomy.
47
Instruments in Ear
Instruments in Ear
b. It can also be used to position the graft and place gel foam
during tympanoplasty
c. To locate the antrum
d. Can be used as a cell seeker.
61. Micro ear curved pick (Cawthorne) (Fig. 1.61)
This is a sharp curved instrument with a number of uses in all
ear surgeries.
Uses:
a. To clear granulation tissue and tympanosclerotic plaques
in the crevices of the mastoid and middle ear
b. To spread the graft during the tympanoplasty
c. To freshen the margins of tympanic perforation
d. Stapedotomy
e. Myringotomy with grommet insertion
f. Facial nerve decompression.
62. Paperella Duckbill micro ear elevator (Fig. 1.62)
It has a handle, shaft and a blunt broad spade like tip.
Uses:
a. To spread graft during tympanoplasty
b. To clear granulation tissue and cholesteatoma in middle
ear and mastoid
49
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51
Instruments in Ear
c. Freshening the margins and undersurface of the perforation during myringoplasty and tympanoplasty
d. To break middle ear adhesions, especially between handle
of malleus and promontory as in a case of atelectasis
e. To clear granulation tissue and cholesteaoma in certain hidden areas of the middle ear like facial recess and sinus tympani.
68. House ear microcurette (Fig. 1.68)
This instrument is used to remove small chunks of bone during
mastoid exploration, stapedotomy, facial nerve decompression
and tympanoplasty. It can remove overhang of bone and bony
spicules near vital structures like facial nerve safely. Posterosuperior bony canal overhang is curetted in superior to inferior
direction to avoid injury to the ossicular chain.
53
Instruments in Ear
Uses:
a. To remove granulation tissue, cholesteatoma, tympanosclerotic plaques from middle ear and mastoid cavity
b. To take a biopsy from middle ear and mastoid cavity
c. To hold and transfer ossicles in the middle ear
d. The curved varieties are useful to reach crevices and
inaccessible areas of middle ear.
71. Wullstein toothed alligator forceps (Fig. 1.71)
This is a straight alligator forceps with two teeth in the lower jaw
and one tooth in the upper jaw that makes the grasp of slippery
materials better. Hence, it can grasp ossicles, grommets, stapes
piston, etc.
72. Straight (A) and right angled (B) micro ear scissors
(Fig. 1.72)
These are fine and delicate single action scissors.
55
Uses :
a. To cut stapedius tendon, tensor tympani tendon
b. To cut middle ear adhesions
c. To cut the freshened margins of the tympanic perforation
d. To cut skin tags during transcanal incision
e. To cut the chorda tympani nerve when required.
57
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Instruments in Ear
59
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61
Staecke in 1891, added meatal skin flap to cover the radical cavity. He
and Zaufal made attic, tympanum and antrum into one cavity which is
known as Staeckes operation. He was the first to approximate the severed
facial nerve intratemporally.
82. Fisch glomus retractor (Fig. 1.82)
Used to retract soft tissues in the mastoid and neck during excision
of glomus tumors.
William Wilde (18151876), was an Irish who studied in London,
Berlin, and Vienna and then settled in Dublin where he was an ophthalmologist and an otologist. He wrote Practical observations on aural surgery,
and the nature and treatment of diseases of the ear. He recommended
incision over the mastoid bone down through the periosteum in fluctuant
mastoiditis. The incision popular even today is known as Wildes incision.
For fostering the growth of otology as a speciality, he is known as Father of
modern otology. He invented angled shaft on aural instruments.
Instruments in Ear
Ossicular implants
Ossicular reconstruction
Materials used for ossicular reconstruction
There are two types of materials
1. Naturalcartilage and bone (Auto and allografts)
2. Biomaterials used for TORP and PORP
a. Hydroxyapatite: the dense variety (Ceramic calcium phosphate)
resembles natural bone, resists degradation and provides
good sound conduction. Besides it can be sculpted and
shaped as per the requirement. It is one of the popular
materials.
b. Titanium: light weight metal, biocompatible
c. Platinum: it is non-corrosive, biocompatible, non-magnetic
and malleable.
d. Stainless steel: good sound conduction, polished surfaces,
resists adhesions
e. Fluoroplastic [Teflon]: excellent sound conduction, smooth,
non sticky surface minimizes adhesions, proven biocompatibility.
f. Gold: malleable, biocompatible.
83. Total ossicular replacement prosthesis [TORP] (Fig. 1.83)
The prosthesis shown is made up of teflon and has a head and
a thin shaft. The shaft is placed on the footplate of stapes. The
graft is placed on the head of the prosthesis in the absence of
malleus. In the presence of malleus, the graft may be placed over
the handle of malleus.
84. Partial ossicular replacement prosthesis [PORP] (Fig. 1.84)
The prosthesis shown here is made up of teflon and has a head
and a thick shaft. The shaft is placed on the head of the stapes.
The graft may be placed on the head of the prosthesis.
63
Instruments in Ear
Stapes instruments
86. Fisch titanium stapes piston (Fig. 1.86)
Available in various sizes and used during stapedotomy.
87. Causse teflon stapes piston (Fig. 1.87)
This is a loop piston made up of teflon available in various sizes
ranging from 0.4 mm to 0.8 mm (diameter of piston shaft). The
length of the shaft is adjusted using a measuring rod and a jig.
65
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67
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69
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71
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73
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75
Instruments in Nose
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79
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81
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83
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85
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87
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movable distally and hence can enter the crevices and spaces
inside the nasal cavity. These scopes can also be used to visualize
the laryngeal inlet and hypopharynx also. The fiberscopes can be
connected to a camera for magnification, better visualization and
recording of the images.
25. Microdebrider [Hummer] console (Fig. 2.25)
This part consists of the power unit and the switch. The power unit
harbors the facility to select the mode of the function required
microdebrider or micromotor. It can also adjust the speed of the
blade, the amount of irrigation and oscillation. The footswitch is
used for controlling blade direction and speed. Oscillation speed
can go upto 30,000 rpm and rotation speed can go upto 70,000
rpm. It can be used in the rotatory or oscillatory modes.
26. Microdebrider handpiece (Fig. 2.26)
The handpiece consists of the rotating blade, irrigation channel
and suction channel.
27. Microdebrider detachable blade and its tip (Fig. 2.27)
The blade is available as straight or curved tips.
93
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95
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spaces of the nasal cavity. The advantage of a single action forceps is that it is more stable and stronger than a double action
forceps. However, the disadvantage is that the space between the
blades of the forceps is limited. It has an eye at the upper jaw to
permit proper visualization of tissue unlike a Takahashi forceps
that does not have an eye.
32. Blakesley through cut forceps (Fig. 2.32)
The upper jaw in a through cut forceps cuts cleanly through tissue to help avoid tearing. In a non-through cut forceps the tissue
is captured between the blades and then cut. For obtaining tissue
for the purpose of biopsies, the latter forceps is more suitable.
33. Blakesley Weil 45 degree upturned forceps (Fig. 2.33)
This forceps is more suitable to reach the structures that are
higher up in the nasal cavity and the lateral wall of the nose.
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Instruments in Nose
the same way, it can also be used to remove the contents of the
maxillary sinus through the ostium.
35. Pediatric Blakesley Weil 45 degree upturned forceps
(Fig. 2.35)
This is a more gentle forceps that is smaller in size than its adult
counterpart. However, the uses remain the same.
36. Flexible cupped forceps (Fig. 2.36)
This is a double action cupped malleable forceps that can be
turned upward, downward or sideward. It can also be used to
grasp bleeding vessels and tissues for cauterization.
37. Nasal endoscopic scissors (Fig. 2.37)
This is an endoscopic single action nasal scissors that opens only
at the tip. It is available as straight, angled and serrated cutting
edge types.
Uses:
a. To trim and resect inferior turbinate
b. Conchoplasty in concha bullosa
c. To resect any other soft tissue in the lateral wall of the nose.
99
Instruments in Nose
101
Instruments in Nose
103
Instruments in Nose
105
S.
Through cut instrument
No.
1.
2.
3.
4.
Cuts and removes the tissues. Removes the tissue by shearHence, no tags are left behind ing forces. Tags can be left
behind.
Does not tear the cutting mu- Can tear or strip excess mucosa
cosa
Shearing forces not involved. Due to shearing forces involved
Hence, less chances of com- the chances of complications
plications.
are more.
Preferred for use near vital Not preferred over vital strucstructures like lamina papy- tures
racea, sphenoid sinus and
arteries
Instruments in Nose
107
Instruments in Nose
109
Instruments in Nose
111
Instruments in Nose
Uses:
a. Removal of lacrimal bone in endoscopic dacryocystorhinostomy
b. Removal of anterior wall of sphenoid sinus
c. Removal of medial wall of maxilla
d. Caldwell-Luc operation
Table 2.2: Comparison between Kerrison rongeur and
Citelli punch forceps
Kerrison rongeur
Non-through-cutting forceps
Through-cutting forceps
Cutting tip is available as up- Cutting tip is available as upward biting and downward biting ward biting 90 degree
in angles of 90 and 40 degrees
113
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115
Instruments in Nose
117
Instruments in Nose
119
Instruments in Nose
121
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123
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Table 2.3: Comparison between Asch and Walsham forceps
Asch forceps (Fig. 2.87)
Walsham forceps
Straight blades
Rubber tube on one tip to protect
skin
Gap seen between prongs on No gap seen on approximation
approximation
Used to elevate and straighten Used to refracture and realign
the nasal bones
the septum
Smaller in size
Stout
Angled blades
No rubber tube on the tip
125
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127
Uses:
a. Diagnostic proof puncture: to obtain aspirate of the maxillary sinus for analysis
b. To drain pus in maxillary sinusitis
c. Instillation of medicine into maxillary antrum
d. Oro-antral fistula.
Procedure of antral puncture:
The nasal cavity is anesthetized with a cotton pledget
soaked in 4% lignocaine. The procedure is performed with
the patient in the sitting position.
The antral puncture is done in the inferior meatus 1 cm
behind the anterior end of inferior turbinate.
The trocar and cannula is directed towards the outer canthus of ipsilateral eye.
The trocar is now withdrawn from the cannula.
The valve end of the Higginson syringe is dipped in the
warm water.
The bulb is squeezed and the sinus is irrigated with water
after connecting the syringe to the cannula.
The patient is advised to breathe through the mouth.
Complications:
a. Laceration of the nasal mucosa
b. Soft tissue injury of the cheek
c. Orbital injury
d. Air embolism
e. Hemorrhage
f. Vasovagal attack
g. Injury to the pterygopalatine fossa through the posterior
wall of maxillary sinus.
Contraindications:
a. Bleeding disorders
b. Age below 3 years
c. Acute maxillary sinusitis.
Instruments in Nose
129
saline for anterior and posterior bleeding. Can be used as an alternative to nasal packing and has the advantage of allowing the
patient to breathe through the nose. It can also be used for nasal
packing following nasal surgeries like septoplasty, rhinoplasty.
Instruments in Nose
131
Instruments in Nose
133
Instruments in Nose
135
Instruments in Nose
137
Instruments in Nose
139
Instruments in Nose
Osteotome
1.
2.
3.
Cannot cut deep into a bone Can cut deep into a bone
141
Instruments in Nose
Uses:
a. For external osteotomy in rhinoplasty
b. For osteotomy cuts in maxillectomy, mandibulectomy, etc.
107. Castroviejo rhinoplasty measuring caliper (Fig. 2.107)
It is used to measure various parameters of the nose during
rhinoplasty. Also used to measure the thickness of cartilage
harvest before grafting in augmentation rhinoplasty. It has a
range of 0 to 15 mm. It can also be used in thyroplasty surgeries.
108. Curved raspatory for rhinoplasty (Fig. 2.108)
Used to elevate cartilage and mucoperichondrium during rhinoplasty.
143
Instruments in Nose
145
Instruments in Nose
147
Instruments in Nose
149
Instruments in Nose
151
Instruments in Nose
33.
34.
35.
36.
153
Instruments in Nose
24.
25.
26.
27.
28.
29.
Hemostatic forceps
Langenbeck retractor
Non-toothed forceps
Yankauer pharyngeal suction tube
Lac tongue depressor
Killian nasal speculum
155
Instruments in Throat
Adenotonsillectomy instruments
1. Boyle Davis mouth gag with tongue blade (Fig. 3.1)
It has two components: Boyle blade and Davis gag that are used
simultaneously. It helps to keep the mouth open and push the
tongue up and away from the operation site. Upper tooth plate
has small holes to which a rubber tube is sutured to prevent
trauma to the incisor tooth. The mouth gag is introduced in the
closed position after opening the mouth with the head extended.
The mouth gag is gradually opened and the ratchet lock makes
it self-retaining. The whole assembly can be lifted up and maintained in that position using Draffin bipods.
Indications:
a. Tonsillectomy
b. Adenoidectomy
c. Surgeries of palate and nasopharynx
d. Excision of choanal polyp.
2. Doughty tongue blade (Fig. 3.2)
It has a slit and groove in the middle to accommodate the
endotracheal tube. This prevents the tube from blocking the
tonsillar dissection.
Instruments in Throat
157
Instruments in Throat
159
Instruments in Throat
161
Instruments in Throat
163
rated end is used to cut the tissues from the upper pole, pillars
and the tonsillar bed till the lower pole is reached.
15. Mollison tonsillar dissector and pillar retractor (Fig. 3.15)
It has a blunt end used for initial atraumatic dissection of the
tonsil. The retracting end is used to retract the anterior pillar to
look for bleeding points and tags of tonsillar tissue left behind.
Instruments in Throat
165
Instruments in Throat
167
Instruments in Throat
169
Instruments in Throat
171
Instruments in Throat
Miscellaneous instruments
29. Lac tongue depressor (Fig. 3.29)
It has a flat end and a slightly curved end. The flat end is placed
over the anterior two-third of the tongue to depress it. The
posterior one-third should not be touched in order to prevent
gag reflex. The following are its uses:
a. Examination of oral cavity and oropharynx
b. To retract lips and cheek
c. To express pus out of the tonsilseptic squeeze test
d. To test gag reflex
e. For cold spatula test to check patency of nasal passage
f. For posterior rhinoscopy
g. For oral cavity procedures like injection of steroids, biopsy,
excision of cysts, etc.
30. St. Clair Thompson quinsy forceps (Fig. 3.30)
It is bayonet shaped instrument with a sharp trocar tip. It has
a guard at some distance from tip to prevent deep entry. For
draining quinsy sharp tip is pierced with the forceps closed. The
instrument is then opened like a sinus forceps to drain the abscess.
173
Instruments in Throat
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.
Structures not seen in this procedure:
a. Postcricoid region
b. Apex of pyriform fossa
c. Ventricles
d. Undersurface of vocal cords and adjoining subglottic region
e. Laryngeal surface of epiglottis.
Pitfalls of indirect laryngoscopic examination:
a. There is anterior and posterior reversal of structures in the
mirror image
b. Overhanging of epiglottis may obscure vision
c. The anterior commissure is poorly visualized
d. Depth perception is poor
e. The procedure is difficult in children
f. The tongue may rise on phonation and may obscure the
view of larynx
g. The procedure is difficult in a person with short neck
h. The vocal cords appear short and flat in the mirror
i. 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.
175
Instruments in Throat
177
Instruments in Throat
Uses:
a. Cleft palate.
b. Uvulopalatopharyngoplasty.
c. Pharyngoplasty.
d. Operations on the nasopharynx.
e. Surgery for choanal atresia.
f. Transpalatal approach to juvenile nasopharyngeal angiofibroma.
g. Sphenoidotomy.
h. Hypophysectomy.
i. Vidian neurectomy.
38. Doyen mouth gag (Fig. 3.38)
It is a self-retaining mouth gag used to open the mouth by anchoring on the teeth for the following:
a. Glossectomy
b. Soft palate and floor of the mouth surgery
c. Tongue tie release
d. Dental surgery
179
Instruments in Throat
181
Instruments in Throat
16.
17.
18.
19.
20.
183
Instruments in larynx,
Trachea and Esophagus
Bronchoscopy
1. Rigid bronchoscope (Figs 4.1A to H)
This is a hollow rigid tube with a beveled end. The adult
bronchoscope is about 40 to 45 cm long. It has vents on the side
for ventilation of the other bronchus when they remain above
the level of carina when inserted into the major bronchus and
hence differs from esophagoscope.
Parts:
a. Handle
b. Shaft or body
c. Distal beveled end with vents
d. Prismatic light deflector: no loss of lumen space due to
light carrier
e. Fluvog adapter for attachment to the proximal end.
f. Tube guide
g. Rubber sealing cap
h. Glass window plug.
Sizes:
A. Adult6.5, 7.5, 8.5
B. Pediatricas given in the table 4.1
Uses:
Diagnostic:
a. For examination of tracheobronchial tree for pathology
growth, ulcer, stricture, etc.
b. Biopsy from a suspicious growth or ulcer
c. Bronchial lavage from secretions
d. Bronchography
e. Autofluorescence and photodynamic diagnosis.
Therapeutic:
a. Foreign body removal
b. Tracheobronchial stenting
c. Aspiration of secretions
d. Removal of tumors.
Gustav Killian (1860-1921), was a German laryngologist, born in Mainz.
He made revolutionary advances in the diagnosis and treatment of intralaryngeal passages, especially the removal of foreign bodies from the bronchial tubes,
by means of his art of bronchoscopic control. He used Bronchoscope, a some-
185
187
189
191
Esophagoscopy
9. Adult rigid esophagoscope (Fig. 4.9)
It is a long rigid hollow tube of 40 to 45 cm length and 16 to
20 mm diameter. It is available as Negus and Jackson type. The
Negus type generally has double proximal illumination, tapers
distally and has markings on it. The Jackson type has single distal
illumination and has no markings and does not taper distally. In
distal illumination, the light can get fogged due to its proximity
to the distal end.
Parts:
a. Handle
b. Eyepiece (Proximal end)
c. Body or shaft
d. Light carrier
e. Distal opening.
193
195
Uses:
a. To remove foreign bodies from the hypopharynx or
cricopharynx
b. To take biopsy from the above regions
c. For cricopharyngeal dilatation
d. Excision of cricopharyngeal webs.
13. Esophageal denture shearing forceps (Fig. 4.13)
This is a pair of stout scissors that is used to cut dentures and
other large foreign bodies in the esophagus to make their removal
easier.
14. Esophageal gum elastic bougie (Fig. 4.14)
This bougie is made up of gum elastic and is available in
various sizes. It is used in the dilatation of esophageal strictures
and stenosis.
197
Larynx
16. Direct laryngoscope (Fig. 4.16)
This is a U shaped instrument made up of German silver. It
uses a rigid fiberoptic light carrier for illumination. The position
of the structures is not changed unlike indirect laryngoscopy
and there is no magnification. Based on the type of illumination
there are two typesJackson and Negus.
Table 4.2: Comparison between Jackson and Negus types
of instruments
S.No
1.
2.
3.
4.
5.
Feature
Site of illumination
Number of illuminations
Brightness
Fogging of light carrier
Proximal size
Jackson
Distal
Single
Less bright
Possible
Narrower
Negus
Proximal
Double
More bright
Unlikely
Broader
Uses:
a. For examination of larynx, hypopharynx, cricopharynx
and upper esophagus
199
It took 40 years after the invention of indirect laryngoscopy for the invention
of direct laryngoscopy and was by Kirstein. Lack of an appropriate light
source was the reason why it took such a long time.
17. Direct laryngoscope with detachable blade (Fig. 4.17)
This direct laryngoscope has a sliding part that can be detached
and removed. Hence, it allows the visualization of posterior
structures and also permits to introduce a bronchoscope especially for difficult cases.
18. Holinger anterior commissure laryngoscope (Fig. 4.18)
The adult scope has a length of 17 cm and has a long fiberoptic
light carrier, hence of Jackson type. The horizontal limb of the
201
203
205
207
these laryngeal stents are kept for less than 6 weeks. Many types
of laryngeal stent are available. Firm stents are used if splinting
is required, solid stent is used if aspiration is a problem and a
soft hollow stent is used if phonation is required.
Uses:
a. For separation of mucosal surfaces during healing following
laryngeal trauma
b. Repair of web formation or atresia
c. Excision of laryngeal lesion.
29. Aboulker laryngeal stent (Fig. 4.29)
This is a hollow long laryngeal stent available in various sizes
ranging from 3 mm to 15 mm diameter. These are coated with
teflon. The uses are same as that of Montgomery laryngeal stent.
209
that pressure on the thyroid cartilage was necessary to reveal the anterior
commissure. He also introduced monocular magnification. He produced a
device with a pressure applicator on the larynx. Originally laryngoscopy
was performed with patient sitting with examiner standing behind. Killian
in 1911, developed suspension laryngoscopy for direct laryngoscopy. This
was modified further by Lynch of New Orleans, and is still used as the
Boston suspension laryngoscope.
Kleinsasser of Germany published a book in 1968 which revolutionized
the operative laryngoscopy. The use of stereoscopic microscope and microear
instruments were modified for use in larynx. Kleinsasser is aptly called the
father of modern microlaryngeal surgery.
31. Kleinsasser anterior commissure operating laryngoscope (Fig. 4.31)
This is a suspension laryngoscope which has a beak at the ventral surface of the distal end that pushes the epiglottis anteriorly
and gives a clear view of the anterior commissure.
211
213
37. Lindholm vocal cord and false cord retractor (Fig. 4.37)
This is an atraumatic self-retaining retractor with ratchet. The
distal end has blunt curved blades for retraction of the true
cords or the false cords. Hence, the subglottic region and trachea
can be visualized during microlaryngeal surgery.
215
217
219
221
Tracheostomy
47. Blunt tracheal hook (Isthmus single hook) (Fig. 4.47)
This is used to retract the isthmus of the thyroid and other soft
tissues during tracheostomy. The sharp tracheal hook is used to
retract the cricoid cartilage superiorly and stabilize the trachea
prior to the tracheal incision during tracheotomy.
48. Down cricoid hook double (Fig. 4.48)
It is a blunt instrument that has two hooks. This instrument is used to
retract soft tissue or strap muscles in the neck during tracheostomy.
49. Trousseau tracheal dilator (Fig. 4.49)
It is an instrument used to dilate the tracheostoma during or
after the tracheostomy to insert the tracheostomy tube. It allows
easier introduction of the tracheostomy tube and prevents formation of a false passage.
Table 4.3: Comparison between tracheal dilator and
artery forceps
Feature
Tracheal dilator
Artery forceps
Pressing the handle Opens the prongs
Closes the prongs
of the instrument
Ratchet
Absent
Present
Inner aspect serrations Absent
Present
223
225
and Jackson
Jackson tracheostomy tube
No flanges
Present
Absent
Present
inner tube in place. There is a pilot for introducing the tube into
the trachea so that injury is not caused to the posterior wall.
Disadvantages:
a. Phonation is not possible
b. The patency of the natural air passage cannot be checked
by blocking the tube
c. There is a risk of granulation tissue formation.
The French gauge (FG or FR) is three times the outer diameter
(millimeters) of the tube. This FG system is commonly followed
for identifying the number of metal tracheostomy tube.
53. non-metallic: portex tracheostomy tube (Fig. 4.53)
Parts:
a. Single tube with collar
b. Cuff
c. Balloon with valve for air
d. Pilot obturator.
227
Advantages:
a. Made up of soft material, hence less damaging to the
tracheal wall
b. Since it has a cuff it is particularly useful for intensive care
unit patients
c. It is useful during radiotherapy
d. It has a blue radiopaque line all along the tube for radiological detection of the site of the tube.
Disadvantages:
a. Cleaning the tube is more difficultrequires removal
b. Phonation not possible usually
c. Checking the patency of natural air passage is not possible
d. Cuff might injure the tracheal wall (tracheal necrosis) if
overinflated and left for a longer period of time. Pressure
should be preferably less than 30 mm of Hg.
The inner diameter in millimeters corresponds to the designated
size of the tracheostomy tube.
229
231
Voice rehabilitation
57. Trocar and cannula for secondary tracheoesophageal
puncture (TEP) (Fig. 4.57)
This is used to make an opening in the tracheoesophageal wall
following total laryngectomy prior to insertion of voice prosthesis. A pharyngeal protector is used to prevent undue damage to
the wall.
58. Pharynx protector for secondary tracheoesophageal
puncture (Fig. 4.58)
This is a hollow tube with a handle used to protect the pharyngeal mucosa from tearing when a tracheoesophageal puncture is
made with a trocar in secondary TEP.
233
235
237
8. Allis forceps
9. Langenbeck retractor
10. Suction tip
11. Laryngeal window markermale/female
12. Thyroplasty rounded perichondrial elevator
13. Silicone block
14. Needle holder
15. Rigid/flexible endoscope
16. Adson toothed forceps
4.6 Tracheostomy set
1. Halsted mosquito artery forceps
2. Hemostatic artery forceps
3. Down cricoid double hook
4. Isthmus single hook
5. Trousseau tracheal dilator
6. Laborde tracheal dilator
7. Fuller/Jackson/Portex tracheostomy tube
8. Allis forceps
9. No: 11 blade for tracheal incision
10. Metzenbaum dissecting scissors
11. Short fine gently curved scissors
12. Langenbeck retractors
13. Needle holder
14. Adson toothed forceps
15. Suction tip
16. Non-toothed forceps
17. Mollison mastoid retractor.
239
General Instruments
General Instruments
241
General Instruments
243
General Instruments
245
Advantages:
1. Bone is cut from within outwards. Hence deeper structures are not injured.
2. The wire can be easily negotiated from a small opening
and hence can be inserted through a small wound to cut
deeply situated bone.
Nowadays the oscillating saw has largely taken over the job
of Gigli saw.
11. Joll thyroid-retractor (Fig. 5.11)
This is a self-retaining retractor with two pairs of blade and
ratchet at one end and a semicircular handle at the other end.
The blades hold the skin flaps and retract the flaps when the instrument is opened with a screw within the handle. This is used
to retract skin, superficial fascia and platysma during surgery on
the thyroid and parathyroid glands.
12. Kocher thyroid dissector (Fig. 5.12)
Used in the dissection of thyroid especially the upper pole.
13. Surgical stapler (Fig. 5.13)
It is used to staple skin incisions in the head and neck instead of
sutures. It is fast and saves time.
Patrick Heron Watson (18321907), a surgeon from Edinburgh England, performed the first laryngectomy in 1866 on a patient with syphilis of
the larynx.The patient died of pneumonia.
General Instruments
247
General Instruments
249
General Instruments
251
General Instruments
253
General Instruments
255
General Instruments
257
General Instruments
259
General Instruments
261
General Instruments
Uses:
a. For catching the ends of blood vessels
b. To hold gauze peanut and stay sutures
c. To step on a knot
d. To clamp drainage tubes and catheters
263
General Instruments
265
General Instruments
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Babcock forceps
Surgical stapler
Suction tip
Mayo scissors
Metzenbaum scissors
Needle holder
Gille skin hook
Mixter dissecting forceps
Adson toothed forceps
Non-toothed forceps
Freer mucoperichondrial elevator
Langenbeck retractors
Bulldog clamp.
267
Appendix
5. Cawthorne
a. Micro ear curved pick
b. Micro ear right angled pick
c. Micro ear straight pick
6. Plester
a. Micro ear flag knife
b. Self-retaining mastoid retractor [33 prongs]
7. Rosen
a. Micro ear round knife
b. Aural speculum [Incomplete split]
c. Curved microcurette
8. Schuknecht
a. Wire bending die
b. Micro ear roller knife
9. McGee
a. Wire stapes prosthesis
b. Stapes piston crimper
10. Wullstein
a. Micro-ear cupped forceps
b. Toothed alligator forceps
c. Mastoid retractor [33 prongs]
Appendix
11. Lucae
a. Micro ear knife [Myringotome]
b. Curved aural forceps
12. Weitlaner
a. Mastoid retractor [34 prongs]
b. Mastoid retractor [23 prongs]
13. Politzer
a. Myringotome
b. Apparatus for eustachian tube function
c. Aural speculum
14. Hartmann
a. Through cutting nasal forceps
b. Tuning fork
c. Aural speculum
d. Aural forceps
15. Zollner [Thumb instruments set]
a. Myringotome
b. Curved pick
c. Microelevator
d. Right angled pick
e. Right angled hook
f. Straight pick
g. Sickle knife
16. Mollison
a. Mastoid retractor (44 prongs)
b. Anterior pillar and tonsillar dissector
271
17. Killian
a. Curved nasal suction tip
b. Bayonet shaped nasal gouge
c. Mucoperichondrial elevator
d. Short and long bladed nasal speculum
18. Tilley
a. Antral bur
b. Nasal gouge
c. Antral harpoon
d. Nasal forceps [With Henkel]
e. Trocar and canula [With Lichtwitz]
f. Aural forceps
19. Freer
a. Double ended mucoperichondrial elevator
b. Chisel
20. Joseph
a. Fine rasp for rhinoplasty
b. Nasal mucoperichondrial elevator
c. Nasal saw
d. Curved rhinoplasty knife
e. Double edged nasal knife
21. Blakesley Weil
a. Upturned 45 degree forceps
b. Upturned 90 degree forceps
Appendix
273
28. Gruenwald
a. Clean bite upturned through cut forceps
b. Through cutting nasal turbinate forceps
29. Hajek
a. Cheek retractor
b. Sphenoid punch [With Kofler]
30. Kilner
a. Alar retractor for rhinoplasty
b. Mouth gag
Instruments with common scientist names
in throat
31. Negus
a. Second artery forceps for tonsillectomy ligation
b. Knot tier and ligature slipper
32. Yankauer
a. Nasopharyngoscope
b. Throat suction tube
33. Ballenger
a. Swivel knife for submucoperichondrial resection of nasal
septum
b. Guillotine for tonsillectomy
Appendix
275
Index
Page numbers followed by f refer to figure and t refer to table
punch rotating backbiter 101, 101f
straight cup curette 108, 108f
Aboulker laryngeal stent 208, 209f
Armstrong
Acute maxillary sinusitis 128
beveled grommet 30f
Adapter for respirator 185f
grommet 31
Adenoid
Asch
tag forceps 182
and Walsham forceps 125t
through cutting forceps 160
forceps 155
Adenoidectomy 156
septal forceps 133, 133f
set 182
Adenotonsillectomy instruments 156 Aspiration of secretions 185
Adson toothed forceps 73-75, 150, Atomizer 252
151, 154, 239, 255, 255f, 266, 267 Aufricht
Adult
coarse rasp for rhinoplasty 139,
esophagoscope 193f
139f
rigid
nasal retractor 153
esophagoscope 193
for rhinoplasty 136, 137f
otoendoscope 12, 13f
Aulus cornelius celsus 172
Air embolism 128
Aural speculum 7, 15, 16, 74
Alligator forceps 54, 54f, 72, 74, 76,
187, 195
B
Allis forceps 151, 154, 239, 240,
241f, 266
Babcock forceps 151, 154, 241, 241f,
Antonio valsalva 9
266, 267
Antral
Ball probe 72
forward cutting straight ring
Ballenger
curette 107, 108f
guillotine 170, 170f, 183
wash set 149
swivel knife 83, 84f, 148
Antrum
curved ring curette 107, 107f, 152 Barany noise box 14, 14f
Bard Parker handle 256f
forward cutting straight ring
curette 152
with blade 72, 75
Bloom singer
and provox prosthesis 234t
prosthesis 235, 236f
Blunt tracheal hook 223
Bobbin grommet 29f, 30
Body level hearing aid 18, 18f
Bone anchored hearing aid 22, 22f
Bowman lacrimal probe 118, 118f, 150
Boyle Davis mouth gag with tongue
blade 156, 157f, 182
Bronchial lavage from secretions 185
Bronchography 185
Bronchoscope forceps 187
forceps with tips 187f
Bruning
laryngeal syringe 216, 217f
syringe 238
Bull lamp 251, 252f
Bulldog clamp 240, 240f, 266, 267
c
Caldwell-Luc
operation 34, 36, 46, 131, 180
set 149
Canaloplasty 58
Cardiospasm 194
Cartilage crusher 144, 145f, 153
Castroviejo rhinoplasty measuring
calliper 143, 144f, 153
Causse teflon stapes piston 65, 65f
Cheatle forceps 265, 265f
Chevalier Jackson 186
Christian Theodor Billroth 247
Citelli punch forceps 114, 114f, 152
Clar headlight 251f
Index
Cleft palate 179
curved mucoperiosteal elevator
181f
elevator 180
Coagulating electrode for thermal
cautery 238
Cochlear implant 23, 24f
Collin tongue holding forceps 176,
176f
Colver tonsillar vulsellum forceps
163, 163f, 182
Combined suction irrigation
cannula 42, 43f
Completely in canal hearing aid 21f
Congenital conductive impairment 22
Contralateral routing of signals
hearing aid 21, 21f
Contrangle handpiece 34, 35f
Cottle
alar retractor and protector 134,
134f, 153
columellar clamp 137, 138f, 153
four pronged alar retractor 136,
137, 153
nasal elevator 84, 84f, 148
Crurotomy knife 70, 74
CSF otorrhea 14
Cupped forceps 187, 195
Curved
pick 59, 72
raspatory for rhinoplasty 144f
Cutting bur 44, 44f, 72, 73, 75
d
Dacryocystorhinostomy 94
Dennis Browne tonsil holding
forceps 161, 162f, 182
e
Ear
hook 2t
level sound processor 22
microsuction tip adapter 35
279
Eye
piece with oblique convex lens 7
protector spoon 125, 126f, 154
f
Facial nerve decompression set 75
Farabeuf
mastoid periosteal elevator 36, 36f
periosteal elevator 72, 75, 149, 154
Farrier speculum 17
Felix Semon 176
Female laryngeal window marker 218
Fenestrated
blades 206
curved forceps 187
Ferguson Ackland mouth gag 178,
178f
Fiberoptic
flexible light cable 204, 205f
headlight 253, 253f
light carrier for
direct laryngoscope 201, 202f
esophagoscope 195, 195f
Fine
delicate gently curved scissors
73, 75
dissection forceps 238
Fisch
crurotomy scissors 70, 74
glomus retractor 62, 62f
titanium stapes piston 65, 65f
Fistula test 7
Flexible
cupped forceps 99, 100f
endoscope 239
fiberoptic
bronchoscope 191, 191f
light cable 237, 238
Index
nasopharyngoscope 92, 92f
sinus guidewire for balloon
sinuplasty 117, 117f
Fluvog adapter 185f
Focus ring 191
Fomon alar retractor 153
for rhinoplasty 134, 134f
Foot switch 32, 34
Foreign body
examination 194
forceps 195
removal 185
Fracture nasal bone reduction set 155
Freer
chisel 141, 142f153
double-ended mucoperichon
drial elevator 82, 82f
mucoperichondrial elevator
148-153, 155, 238, 266, 267
Frenzel
maneuver 8
nystagmus spectacles with
inbuilt battery handle 17f
Friedrich Bezold 5
Frontal sinus
curette 109, 109f
wall drilling 34
Fuller
and Jackson tracheostomy tubes
226t
bivalved tracheostomy tube 225
g
Gabriel fallopius 131
Gardiner tuning fork 6, 6f
General
ear instruments 1
instrument
sets 266
with common scientist names
275
nose instruments 77
Gigli saw 154
wire 266
with handle 245, 245f
Gille skin hook 151, 154, 238, 243,
244, 266, 267
GJ Jenkins 46
Glass
bottle containing local anesthetic
252
window plug 184
Glegg aural snare 61, 61f
Goode T tube 28f
Grip rings 206
Grommet introducer 31, 31f, 72
Groningen prosthesis 235, 236f
Gruber speculum 17
Gruenwald
clean bite upturned through cut
forceps 103, 103f 152
through cutting nasal
forceps 152
turbinate forceps 104, 105f
Guiding probe 177, 177f
Gunnar Holmgren 250
Gustav Killian 185
Gwynne Evan tonsillar dissector
163, 164f182
h
Hajek
cheek retractor 131, 132f, 149, 154
Kofler sphenoid punch 114,
115f, 153
281
Herbert Tilley 86
Heuwieser antrum grasping forceps
102, 102f, 151, 152
Heymann turbinectomy scissors
120, 120f, 150, 152
Higginson syringe 121, 122f, 149
High pressure handle 216, 217f
Hildyard postnasal forceps 109, 110f
History of tonsillectomy 172
Holinger anterior commissure
laryngoscope 200
scope 201f, 238
Holmgren
adjustable aural speculum 16
self-retaining aural speculum 15f
Hopkins optical
forceps 237
for bronchoscope 189, 190f
telescope for bronchoscope
forceps 189, 189f
House
dieter malleus head nipper 57,
57f, 73
ear microcurette 53, 53f, 73, 74
graft press forceps 46, 46f, 73
measuring rod 68f
micro ear curette 73, 75
piston measuring rod 74
stapedectomy piston measuring
rod 68
Howarth nasal septal elevator 85,
85f, 148
Humby
knife 260
skin
graft blade holder 261f
knife holder 154
Index
Hydroxyapatite 63
Hypopharyngoscope 195
with light deflector 196f
Hypopharyngoscopy set 237
Hypophysectomy 179
i
Impedence audiometry 8
Indirect laryngoscopy mirror 174,
175f
Injection cannula for bronchoscope
jet ventilation 189, 190f, 237
Inserting bronchoscope 202
Instillation of medications 7
Instrument
guide for suction catheter 185f
in ear 1
in larynx, trachea and esophagus
184
in nose 77
in throat 156
sets for
ear surgeries 72
nose surgeries 148
throat surgeries 182
sets in larynx, trachea and
esophagus 237
with common scientist names in
ear 269
larynx, bronchus and
esophagus 275
nose 272
throat 274
Internal
nasal
septal splint 87, 88f
splint 148
osteotomy 153
j
Jackson
and Negus types of instruments
199t
tracheostomy tube 226, 227f
Jansen
33 pronged mastoid retractor 40f
bone nibbler 123, 123f, 149, 151,
154
chisel 142, 143f
mastoid retractor 40, 72
Middleton
nasal forceps 148
septum forceps 132, 132f, 154
nasal chisel 153
Jenkin mastoid gouge 45, 46f, 72, 75
Jenning mouth gag 171, 171f
Jobson-Horne
ear probe with ring curette 1
probe with ring curette 1f
Joll thyroid retractor 246, 246f, 266
Jonathan Wathen 10
Joseph
curved rhinoplasty knife 146,
146f, 153
double edged nasal knife 146,
146f, 153
fine rasp for rhinoplasty 140
nasal
elevator 148
283
K
Kerrison
Costen rongeur 113, 113f, 152
double action bone nibbling
forceps 122, 122f, 149, 154
rongeur 112, 112f, 150
and Citelli punch forceps 113t
Killian
bayonet shaped nasal gouge 86, 86
curved nasal suction tip 150, 152
mucoperichondrial elevators
83, 83f
nasal
gouge 148, 149, 154
speculum 148-155
short and long bladed nasal
speculum 78, 79f
Kilner
alar retractor 153
for rhinoplasty 1 135, 135f
mouth gag 171, 171f
retractor for rhinoplasty 2 135,
136f
Kleinsasser
anterior commissure operating
laryngoscope 211, 211f
suspension laryngoscope 238
for microlaryngeal surgery 210
Knight nasal polyp forceps 126,
127f, 151
Kocher
artery forceps 242, 242f, 266
thyroid dissector 246, 247f, 266
Krause nasal snare 131, 131f, 151
Kuhn-Bolger frontal recess giraffe
forceps 114, 115f, 152
L
Laborde tracheal dilator 223, 239
Lac tongue depressor 148-151,
153-155, 173, 173f, 266
Laceration of nasal mucosa 128
Lacrimal
punctum dilator 117, 118f, 150
syringing needle 118, 119f, 150
Laforce adenotome 161, 161, 182
Lane tissue forceps 242, 243f, 266
Langenbeck retractor 149, 151, 155,
239, 256f, 257f, 266, 267
Large hygroscopic foreign body 14
Larkin hand perforator bur 69, 69f, 74
Laryngeal
angled
blunt hook 213f, 214
sharp hook 213f
blunt double hook retractor
213f, 214
calipers 218f, 238
for thyroplasty 218
cupped
biopsy forceps 238
forceps 214f
needle 216f, 238
for injection 216
peeling knife 214
right angled knife 213f
scissors for MLS 214
sickle knife 213f, 214
Index
Magill forceps 206, 206f
Mahadevaiah mastoid retractor 41,
41f, 72
Main rigid pediatric bronchoscope
185f
Male laryngeal window marker 218
Mandibulectomy 34
Manoel garcia 176
Masing chisel 153
for osteotomy 140, 140f
Mastoid microgouge 48, 48f, 73, 75
Mastoidectomy 32, 37, 58
set 72
Maxillectomy 131
set 154
Mayo
scissors 151, 154, 242, 243f, 266,
267
towel clip 264, 264f
McGee
stapes piston crimper 70, 70f, 74
wire stapes prosthesis 65, 66f
McIndoe nasal fine wound retractor
135, 136f, 153
Medialization thyroplasty set 238
Merocel nasal dressing 133, 133f
Metallic and non-metallic tracheo-
stomy tube 229t
Metzenbaum
dissecting scissors 239, 243, 244f
M
scissors 73, 75, 151, 154, 238,
Macewen
266, 267
cell seeker and curette 47
Micro ear
curette and cell seeker 47f, 73
ball
MacIntosh laryngoscope 201,
point probe 73, 75
202f, 237
probe 48, 48f
MacKenzie laryngeal forceps 203, 204f curved pick 49, 49f, 73, 75, 76
Magauren plate 158, 158f, 182
right angled pick 50, 50, 73, 75, 76
straight
cupped forceps for MLS 214
probe 213f, 214
scissors for MLS 215f
suction tip 238
window marker 219f, 239
Laryngectomy 266
Larynx 199
Lateral rhinotomy set 151
Lempert
endaural
mastoid retractor with third
blade 41, 42f
retractor with third blade 73
speculum 42, 43f, 73, 74, 75
mastoid
curette 47, 47f, 73, 75
suction tube 44, 44f
Light carrier 193
Lindholm vocal cord and false cord
retractor 215, 215f, 238
Lister sinus forceps 262, 263f
Luc forceps 148, 150, 151, 154,
254, 254f
Lucae
curved aural forceps 4, 5f, 74, 76
micro ear knife 26, 27
myringotome 72
285
Montgomery
esophageal tube 197, 198f
laryngeal
keel 206, 207f
stent 207, 208f
T tube 231, 231f
thyroplasty implant 221, 222f
tracheostomy speaking valve
229, 230f
Morell Mackenzie 172
Mosquito forceps 151
Muck forceps 162, 163f, 183
Myle nasoantral perforator 129,
129f, 149
Myringotome 26, 27f, 59
N
Nasal
chisel 141, 141f
straight 153
douching in atrophic rhinitis 122
endoscopic
scissors 99, 100f, 152
sickle knife 94, 95f, 150, 152
foreign body hook 81, 81f
packing forceps 148-155
polypectomy set 151
probe for submucous diathermy
123, 123f
rigid endoscopes 90, 90f
septal internal splint 150
suction tip 148-154
Neck dissection set 266
Needle holder 73-76, 148-150, 153,
154, 239, 258, 258f, 266, 267
Index
Negative Rinne test 5
Negus
knot tier and ligature pusher 167,
182
second artery forceps 166, 166f,
182
Non-endoscopic nose surgeries 120
Non-metallic tracheostomy tube 229t
Non-toothed forceps 149, 151, 155,
239, 254, 255f, 266, 267
Nose piece 11
O
Ohm atomizer 253f
Operating microscope 248, 249f
Optic nerve guide 154
for evisceration 125, 126f
Optical
system 248
telescope for bronchoscope
forceps 237
Orbital injury 128
Ossicular
implants 63
prosthesis 64f
reconstruction 63
sculpting 34
Ossiculoplasty set 73
Osteotome 142, 143f, 151f, 154, 153
Ostrum backbiting forceps 100,
101f, 152
Otitis externa 14
Otoscope 11, 11f
P
Paperella duck bill micro-ear
elevator 49, 50f, 73, 75, 76
R
Rampley
sponge holding 264f
sponge holding forceps 264
287
S
Samuel Rosen 71
Schuknecht
roller knife 59, 60f, 74, 76
wire bending die 67f
Sealing plug for respiration
connector 185f
Septal
aspirating elevator 82, 83f, 148
buttons with connector for septal
perforation 89, 89f
elevator 73, 75
internal nasal splint with airway
87, 88f
mucoperiosteal elevator 72, 75
surgery
instruments 82
set 148
Severe pain 9
Shah
large grommet 29f
type ventilation tube 30
Sharp short gently curved dissecting
scissors 256, 257f
Index
Shea
aural speculum 16f, 17
piston measuring rod 74
stapedectomy piston measuring
rod 67
Sheehy type grommet 28, 28f
Shepard
grommet 30
large grommet 29f
Short
fine gently curved scissors 239
sharp scissors gently curved 148
Sickle knife 59
Siegel pneumatic speculum with
bulb 7, 7f
Silicone block 239
for thyroplasty 221, 221f
Simpson aural syringe 12, 13f
Singer laryngectomy tube 230, 231f
Sinus
balloon
catheter for balloon
sinuplasty 116, 116f
inflation device for balloon
sinuplasty 116, 116f
guide catheter for balloon
sinuplasty 117, 117f
ostium ballpoint probe 95, 95f,
96f, 96, 152
trocar and cannula 91, 152
for endoscopy 91
Sir William Macewen 48
Sizes of pediatric bronchoscopes for
various ages 186t
Skin graft blade holder with handle
260
Soft tissue injury of cheek 128
Sonotubometry 8
Sphenoidotomy 179
289
Toynbee maneuver 8
Tracheal
dilator and artery forceps 223t
flange 234
transverse diameter 229t
Tracheobronchial stenting 185
Tracheoesophageal
fistula 194
T
puncture 233
Takahashi nasal surgery forceps
Tracheostomy 223
111, 111f, 152
set 239
Teeth protector 237, 238
Transantral ligation of maxillary
Teleotoscope 72
artery 131
Thinned out tympanic membrane 14
Transmission cable 32
Thudicum nasal speculum 77, 77f,
Trautmann micro ear knife 60, 60f
148
Troeltsch aural forceps 3
Thyroplasty 218
Trousseau tracheal dilator 223, 224f,
mucoperichondrial elevator
239
sharp 220, 221f
Tube
guide 184
rounded perichondrial elevator
Tumarkin aural speculum 16f, 17
220f, 239
Tuning fork 5
Tilley
Turbinectomy set 150
antral
Tympanic membrane rupture 14
bur 120, 121f, 148
Tympanoplasty 32, 37, 73
harpoon 124, 124f, 148, 149
aural forceps 4, 4f
Henkel forceps 104f, 152
U
Lichtwitz trocar and cannula
Upper end esophagoscope 195
127, 127f, 149
Uvulopalatopharyngoplasty 179
nasal gouge 86, 87f, 148
Tonsillectomy 156
set 182
V
Tonybee speculum 17
Valsalva maneuver 8
Toothed
Verhoeven
alligator forceps 187
ear microsuction tip 35f
serrated alligator forceps for
microsuction tip 35
slippery foreign bodies 187f
Vibrating ossicular prosthesis 22
Total ossicular replacement
Vidian neurectomy 131, 179
prosthesis 63, 64f
Index
mastoid retractor 72
self-retaining mastoid retractor 40
Walsham forceps 124, 125f, 154, 155
toothed alligator forceps 55, 56f,
Walter rhinoplasty scissors 138,
74, 76
138f, 139f153
Waugh tenaculum forceps 168,
Y
168f, 183
Weitlaner
Yankauer
23 pronged mastoid retractor
nasopharyngoscope 177, 177f, 182
2 39f
pharyngeal suction 148, 149,
34 pronged mastoid retractor
150, 151
1 39f
tip 154
mastoid retractor 1 39
tube 155, 182, 183, 266
William Watson
suction tube 169, 169f
coarse rasp 144, 153
Yasargil microscissors 112, 112f, 152
curved coarse rasp 145f
Yorke hemostatic tonsillar clamp
nasal
168, 168f, 182
forceps 152
polyps forceps 104, 105f
Wilson artery forceps 167, 167f, 183 Z
Wire cutting scissors 180, 180f
Zollner
Wullstein
micro ear instrument set 59
33 pronged mastoid retractor 40f
cupped forceps 54, 55f
set 59f
straight 74, 76
speculum 17
291