By William Macnee
This scientific reference for practitioners bargains a brand new and entire examine power obstructive lung disorder. international in scale and significance, it really is a massive explanation for morbidity and mortality. Bringing jointly a roster of across the world well known individuals from front traces of pulmonary drugs and examine, persistent Obstructive Lung illnesses is geared toward practitioners in pulmonary medication, pathology, thoracic radiology and epidemiology. Its concentration is at the pathobiology of persistent obstructive pathology illness and emphysema and its exacerbation of persistent obstructive pulmonary illness and on therapies.
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CHAPTER 3 M YRINGOPLASTY AND T YMPANOPLASTY Charles D. Bluestone, MD In this chapter, I describe operative procedures for repairing a perforation or a retraction pocket of the tympanic membrane with myringoplasty or tympanoplasty. The tissue technique for myringoplasty and tympanoplasty may be medial (underlay) or lateral (overlay, onlay), and the approach may be transcanal (transmeatal), endaural, or postauricular (see Chapter 2). SELECTION OF APPROACH AND TECHNIQUE Myringoplasty is used when there is no need to enter the middle ear, whereas tympanoplasty is indicated when the middle ear requires inspection.
Indications • Presence of a retained unilateral tympanostomy tube in children who are 6 years of age or older, when the contralateral tympanic membrane is intact and the middle ear has been free of disease for 1 year or more • Select children younger than 6 years of age, depending on the factors listed above Tympanostomy Tubes and Related Procedures 17 • Presence of retained bilateral tympanostomy tubes in children in whom eustachian tube function is now considered within normal limits owing to either growth and development, nonsurgical management (eg, allergy control or treatment), or surgery (eg, adenoidectomy, repair of cleft palate) • Presence of frequently recurrent otorrhea through a tympanostomy tube that is not prevented by antimicrobial prophylaxis • Important factors in decision-making are frequency, severity, and duration of the episodes; age of the patient; and duration that the tube has been in place.
Figure 2–20 A transcanal incision is made with a Rosen flap knife to create a Koerner flap. Approaches to the Middle Ear and Mastoid 35 • Canal incisions are extended laterally (Figure 2–21). • A Koerner flap is back-elevated a few millimeters laterally in the canal to facilitate identification of the incisions and elevation of the flap from the postauricular approach (Figure 2–22). A piece of Super Sorb Micro Eye Sponge large enough to fill the canal medial to the incisions also aids in identifying the canal incision, and prevents inadvertently and prematurely entering the middle ear.