Answer:

a) complications of either a general or local anaesthesia.
b) operative damage to:
i) the external auditory meatus (bleeding)
ii) middle ear structures e.g. tympanic membrane, incus, stapes, incudo-stapedial joint, CN VII, chorda tympani (particularly with a high posterior incision)
iii) a high lying jugular bulb
iv) loss of the grommet in the middle ear

c) post-operative complications:
i) persistent discharge
ii) acute infection.

d) Late complications:
i) inflammatory reaction to the grommet
ii) blocked ventilation tube
iii) tinnitus
iv) tympanosclerosis
v) perforation
vi) damage to the middle layer of the tympanic membrane leading to scar formation.

Answer: 

The nerve may be identified peripherally using the following techniques:

• a) the mandibular branch may be identified as it crosses the posterior facial vein, lying on the masseter above the angle of the jaw, just anterior to the lower pole of the parotid gland
• b) a skin flap is elevated beyond the anterior border of the parotid gland. The individual branches are identified with the aid of a facial stimulator and traced from before backwards.
• c) the Temporal and zygomatic branches can be identified as they cross the zygoma, lying directly on the periosteum.

Thus it is not necessary to go through the salivary gland tissue to expose these nerves.
However, loss of these branches leads to the major incapacity of inability to close the eye.

Answer: 

1. An attack of peritonsillar abscess (Quinsy)
2. Recurrent attacks of acute tonsillitis causing unacceptable periods of absence from
   either school or work.
3. As a biopsy when malignancy is suspected or when there is metastatic malignant
   neck node with no known primary
4. Recurrent tonsillitis associated with exacerbations of middle ear disease.
5. Recurrent tonsillitis associated with acute rheumatism, glomerulonephritis and
   psoriasis.
6. Tonsillar enlargement causing upper airway obstruction
7. Where tonsillitis is believed to predispose to attacks of bronchitis and sinusitis
8. Carrier states of streptococci and diphtheria bacilli
9. As biopsy when tuberculosis of the tonsil is suspected.
10. To facilitate approach to the glossopharyngeal nerve and styloid process
11. Occasionally prior to cleft palate repair.

Initially adequate suction is required followed by occlusion of the bleeding point with

• Pledget
• Ribbon gauze
• Fogarty catheter or
• Thompson blockers.

While local of the bleeding is performed it is essential to ensure the other lung is being adequately ventilated and slight withdrawal of the bronchoscope may be required to achieve this. Adequate intravenous is important. In general the bleeding ceases after a short period of time. Continued bleeding requires intervention and advise of a Cardiothoracic surgeon should be sought.

Answer:

1. Haemorrhage
2. Inhalation of blood, debris or teeth
3. Dislocation of TMJ.

1. Otitis media
2. Secondary haemorrhage

1. Residual adenoid tissue
2. Hypernasality from velopharyngeal incompetence
3. Eustachian tube dysfunction
4. Subluxation of the atlanto-axial joint
5. Palatal scarring
6. Psychological trauma resulting from a stay in hospital.

Answer: 

1. Tracheostomy tube with a speaking tracheostomy tube.
2. Vocal cord lateralization procedure. This includes Woodman’s procedure, transthyroid alar suture and suture lateralization of thearytenoid
3. Cordectomy . A laser may be used for this.
4. Tucker’s procedure where a segment of the innervated omohyoid is implanted into the posterior crico-arytenoid muscle in an attempt to return arytenoid movement. This procedure is widely used. A lateralization procedure is always a ‘trade off’ between increasing the airway and reducing the voice.

Answer:

1. Fascial slings from the perioral region are suspended from either the bony orbital margin, zygoma or temporalis fascia
2. Face lift. This is usually combined with the fascial suspension
3. Masseter muscle transposition to the perioral area
4. Temporalis muscle transposition
5. Digastric muscle transposition
6. Free palmaris longus grafts with neurotisation from the normal side and nerve grafts between the normal and paralysed side have been reported.

7. Selective neurectomy or myomectomy of hyperactive muscles on the normal side has been advocated to aid symmetry.

Answer: 

1. Ventilation tubes insertion
2. Endolymphatic sac decompression / drainage
3. Labyrinthectomy i) membranous ii) total
4. Ultrasonic labyrinthine destruction
5. Vestibulotoxic chemotherapy (streptomycin)
6. Vestibular nerve section.

1. Tack saculotomy
2. Cervical sympathectomy
3. Cryosurgery of the cochlear

Answer: 

Tissue expanding balloons are used in a situation where there is lack of good quality locally available non- scarred skin/tissue. A non-inflated silicone bag with an attached one way inlet valve is surgically inserted under the tissue that is to be expanded. Once a week saline is injected into the one-way valve expanding the bag and consequently the overlying tissue. When a satisfactory excess of tissue has been produced (i.e. 3 to 6 months later), the implant is removed and the excess tissue applied to correct the defect for which it has been designed.