June 2014, a ppt for DLO and MS ENT postgraduate students lecture by Prof Dr.G.Gananathan MS DLO FICS, then HOD & Prof of MMC, on endoscopic and ct relevence to lateral wall of nose and paranasal sinus.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Cochlear Fluid is the one of the most important fluid not only for hearing sensation but also for the balance of human body. It is very important to know the embryology, anatomy, and physiology of cochlear fluid mechanism to know the various pathological conditions of inner ear.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Cochlear Fluid is the one of the most important fluid not only for hearing sensation but also for the balance of human body. It is very important to know the embryology, anatomy, and physiology of cochlear fluid mechanism to know the various pathological conditions of inner ear.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
surgical anatomy of nose is a humble attempt to make the anatomy of nose simpler and easy for medical students and fellow physicians. at the end of the presentation the students will be able to identify all the structures.
Social and Preventive Medicine Classroom discussion topic on types of Epidemiological study designs available.
sole reference is Park text book 20th edition
a short ppt for Casualty group discussion- not all patients presenting with Chest pain are affceted with Cardiac ailments.
prepared and presented in 2008
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2.
A systemic approach to reading a CT PNS includes
Evaluation of patient’s sinus anatomy with its
variations
Determinig the presence of disease
Looking for potential areas of occlusionof drainage
pathways
Computer Tomography of Paranasal Sinuses
3.
To master FESS
Perfect anatomy
Familiarization of radiological landmarks
3D reconstruction
Cross sectional anatomy of FESS
Handling of scope and instruments
Not to panic when entering neighbouring areas
Management of bleeding
4.
Ask for 3 planes-coronal, axial and sagittal
Axial view- Patient’s hard palate is perpendicular to the CT
scanner table , so the External Auditory Canal is in line with
the infra-orbital rim.
Coronal view- Patient’s hard palate is parallel to the scanner
table.
Soft tissue and bone window settings
Screening CT – 5-10mm , 1-2mm, 0.5mm
Settings 1700-2300 HU , centre around +100 to +300 with
130 KV collimation of 2 x 1.5mm with rotation time of 1
second
Protocol of CT
5.
A patient undergoing FESS has to get a CT prior to the
procedure after completion of maximal medical therapy.
The scans are read twice :
once to study the anatomy and its variations and
then again to study the pathology
It is advisable to start reading the scans from the scout
view and then read it frame by frame without jumping
erratically
The navigation is complementary to the CT allowing the
surgeon to orient himself in different planes intra-op
When to Order CT
13. Frontal Recess in Axial Cuts
Axial cuts
Showing
Transition from
frontal sinus to
Frontal recess.
Viewed from top
Downwards.
Anterior wall is
Thicker.
(Naso-Frontal
Beak )
37.
Fresh cadaver dissection platform to fine tune skills
Fresh frozen preferred over formalin preserved as
tissues are more pliable and anatomical details are
closest to living tissues
Nasal Endoscopy – 3 passes
Cadaver Dissection
38.
39.
Note the following
structures
Inferior turbinate
Middle turbinate
Axilla of middle turbinate
Uncinate process , Bulla
ethmoidalis
Accessory ostia
Tubal elevation,
Eustachian tube
Fossa of Rosenmuller
Superior turbinate,
Sphenoidal os
41.
Steps
Lateralisation of Inferior turbinate at the level of
anterior end of middle turbinate using Freer’s elevator
(this increases room for manipulation in middle
meatus)
Indentify the free border of uncinate process
Identify junction of the upper 2/3rdand loer 1/3rd of
the uncinate process (corresponds
Uncinectomy
42.
43. Steps
Mucosa of the medial surfaces of the horizontal portion of
the uncinate is debrided away.
Lower portion of uncinate bone is dissected away with
sickle knife.
The mucosa of the lateral surface of uncinate is retained. A
vertical cut is made at its anterior end.
A scissor is used to cut the mucosa , flush with the roof of
the maxillary sinus as far as the accessory ostium
The inferiorly based uncinate flap is now draped over the
raw surface created over the superior aspect of the inferior
turbinate.
Middle Meatal Antrostomy
47.
Anterior Ethmoid
The bulla is the largest
anterior ethmoid air cell
6 walls
Anterior wall
Medial wall-related to the
lateral wall of Hiatus
Semilunaris Superioris
Lateral wall- lamina payracea
Posterior wall- related to
retrobullar recess
Superior wall – could be
attached to skull base /
related to suprabullar recess
Inferior wall
48.
49.
Anterior ethmoidal neurovascular bundle running
obliquely from posterior to anterior , and lateral to
medial.
Small portion of anterior fovea between posterior
wall of frontal sinus and anterior ethmoidal artery.
50.
Boundaries
Anteriorly : ground lamella
Posteriorly : anterior wall of sphenoid
Laterally : lamina payracea
Superiorly : posterior skull base
Medially : superior turbinate
Steps
Identify ground lamellaand gentally slide Blakesley forceps
along the horizontal attachment of middle turbinate.
Perforate the basal lamella medially and inferiorly using the
forceps.
Remove all cells till the posterior skull base is identified.
The skull base descends inferiorly towards the posterior aspect.
Posterior Ethmoid
51.
Intermediate approach
Follow the inferior wall of bulla towards posterior end of
middle turbinate.
Use the debrider directed medially taking care not to
damage the septal mucosa.
The anterior end of superior turbinate is identified.
Push superior turbinate gently laterally and identify the
sphenoid os.
Using forceps resect the inferior third of superior turbinate.
Sphenoid os is visualized now.
Using Stammberger mushroom punch forceps sphenoid os
is widened.
Sphenoid Sinus
52. Following structures are seen in sphenoid sinus
Orbitel apex
Optic nerve
Internal carotid artery
Sellar floor
Structures in Sphenoid