Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Thyroid and parathyroid glands

Core Procedures Thyroid lobectomy and isthmusectomy Total thyroidectomy/near-total thyroidectomy Sistrunk procedure (resection of a thyroglossal duct cyst) Parathyroidectomy Subtotal parathyroidectomy and transcervical thymectomy Parathyroid autotransplantation Parathyroid cryopreservation Central neck dissection The thyroid gland takes its name from the Greek words ‘ thyreos ’ (shield) and ‘ edido s’ (form) because of its shape and position in the anterior central neck. The parathyroid glands are named for…

Larynx

Core procedures Outpatient Transnasal flexible diagnostic endoscopy Transoral rigid diagnostic endoscopy Vocal fold medialization injection Vocal fold biopsy via channelled endoscope Inpatient Diagnostic ± therapeutic rigid laryngoscopy/pharyngoscopy Laryngeal framework surgery Total laryngectomy/pharyngolaryngectomy Partial laryngectomy Outline of voice production The primary function of the larynx is to act as a sphincter to prevent the entry of foreign material into the tracheobronchial tree. To achieve this, the vocal…

Pharynx

Core Procedures Tonsillectomy Transoral robotic surgery Adenoidectomy Nasopharyngectomy Embryology Lymphoid tissues develop at several sites around the oro- and nasopharynx. In each case the endodermal epithelium proliferates and grows into the surrounding neural crest mesenchyme as solid buds, which form fossae and crypts. Lymphoid cells accumulate around the crypts from the fifth month and become grouped into lymphoid follicles. Four pairs of invaginations form the tubal…

Neck

Core Procedures Neck dissection (selective (also called functional), modified radical and radical) Submandibular gland excision Branchial cyst excision Lymph node biopsy Access for microvascular anastomosis The anterior neck extends from the skull base (inferior surface of the clivus) above to the root of the neck below. From a surgical perspective, it may be divided into anterior and posterior triangles ( Fig. 15.1A ), which are further…

Temporal bone

Core procedures Tympanoplasty Stapedectomy Cochlear implantation Mastoidectomy Labyrinthectomy Endolymphatic sac surgery Facial nerve exploration/transposition/repair Congenital malformations Petrosectomy The temporal bone contains the organs of hearing and balance. The facial nerve, internal carotid artery, sigmoid sinus and jugular bulb passage through it or adjacent to it. These are all very important or vital structures and a thorough knowledge of temporal bone anatomy is necessary for those who…

External and middle ear

Core Procedures Surgical approaches Transcanal Endaural Retroauricular Canaloplasty Osteoma/exostosis Middle meatal stenosis Tympanic membrane Myringotomy tube Myringoplasty. Tympanoplasty: small, medium and large perforations Ossiculoplasty Basic situation one: malleus and stapes present, incus missing Basic situation two: incus and stapes missing; mobile versus fixed footplate Basic situation three: stapes only – mobile stapes; mobile footplate; fixed footplate Stapedotomy Mastoidectomy: canal wall up versus canal wall down A…

Salivary glands

Core Procedures Parotid gland: superficial parotidectomy, total parotidectomy Submandibular gland: excision of submandibular gland Sublingual gland: excision of sublingual gland, excision of ranula The salivary glands are exocrine glands that discharge saliva via a duct into the oral cavity. Grossly, these can be divided into three major pairs of glands, including the parotid, submandibular and sublingual glands, and over 400 minor glands, including those in the…

Mouth

Core Procedures Cleft lip and palate repair Submandibular calculi and sublingual gland removal Maxillary access for trauma or orthognathic surgery Mandibular orthognathic surgery and trauma surgery Anaesthesia for dentistry Embryology The oral cavity is demarcated as early as the fourteenth day of fetal development by the appearance of the prechordal plate. The endodermal thickening of the prechordal plate contributes to the oropharyngeal membrane, a temporary membrane…

Temporomandibular joint

Core Procedures Closed Procedures Arthrocentesis Arthroscopy Open Joint Procedures Discectomy Disc plication Eminoplasty Total joint replacement Open reduction and internal fixation of fractured condyle The temporomandibular joint (TMJ) is a bilateral diarthrodial, ginglymoid synovial joint, which is mobile independent of the motion of the contralateral joint. Upper and lower joint spaces within each joint are separated by an articular disc of fibrocartilage. The TMJ is unique…

Infratemporal fossa and pterygopalatine fossa

Core Procedures Pathology in the Infratemporal and Pterygopalatine Fossae Biopsy Partial/selective excision Total clearance/compartment resection Route for more proximal surgery Open Approaches Lateral Anterior Inferior Superior Combinations Endoscopic Approaches Endonasal Transmaxillary Transpterygoid Combinations The space behind the maxilla (retro-maxilla) and beneath the skull is principally occupied by the infratemporal fossa (ITF) and pteryogo­palatine fossa (PPF). These are well-defined spaces that contain masticatory muscles and neurovascular structures,…

Nose and paranasal sinuses

This chapter is divided into two sections, dealing with the nose and paranasal sinuses, respectively. Nose Core Procedures Endoscopic ligation of the sphenopalatine artery Septorhinoplasty Surface landmarks The proportions of the nose and face should be carefully evaluated ( Fig. 8.1 ). The angle of rotation and tip projection, height of the dorsum and any existing asymmetry are often key points to be addressed during surgery.…

Orbit and orbital adnexae

Core Procedures Anterior approach to upper eyelid ptosis repair External dacryocystorhinostomy Anterior orbitotomies in four quadrants Transcutaneous and transconjunctival orbital decompressions Clinical anatomy The orbit is a quadrilateral pyramid, with its base facing forward, laterally and slightly inferiorly. It contains the globe, extraocular muscles, nerves, vessels and some associated structures such as the nasolacrimal apparatus ( Ch. 6 ). The volume of the adult Caucasian orbit…

Orbit and orbital trauma

The paired orbits housing the globes are highly evolved and specialized structures that maintain the structural integrity of the globe and the highly complex coordinated movements that facilitate binocular vision. The neuromuscular mechanisms are complex and require considerable neurological investment, in that, of the twelve cranial nerves, three nerves are required for eye movement and one for visual information, with one contributing to the control of…

Face and scalp

Core procedures Management of scalp lacerations Development of the scalp coronal or bicoronal flap to give access to the upper facial skeleton and for craniofacial surgery Donor site for reconstruction to cover defects by mobilization of a variety of scalp flaps Use of part of the scalp primer as a vascularized flap to cover defects in craniofacial surgery, particularly to line the frontal sinus Scalp Clinical…

Osteology of the facial skeleton and naso-ethmoidal complex in relation to trauma

Core Procedures Surgical exposure of fracture articulations Reduction of displaced facial fractures Osteosynthesis of fracture sites The facial skeleton provides a framework for housing the special senses of vision, taste and olfaction; the muscle attachment of the sphincters of the orbit and mouth; and the articulating apparatus that allows movement of the mandible against the maxilla to facilitate mastication. Facial appearance and symmetry depend in part…

Overview of the head and neck

This chapter contains an overview of the topographical anatomy of the head and neck. These anatomical regions are probably amongst the most complex in the body because so many structures are contained within a relatively small area. The head contains the brain (see Section 3) and specialized sensory organs such as the eyes, ears, nose and oral cavity (for taste appreciation). The head and neck collectively…

Improving surgical performance through human factors recognition and enhanced team working

Human error is a significant cause of personal and organizational mistakes, and the need to recognize and address human factors (HF), performance optimization and team dynamics is essential to improve patient safety. Surgical errors are usually multifactorial rather than the fault of one individual: organizational issues, team dynamics and HF are often at the root of many incidents. The World Health Organization (WHO) surgical checklist and…

Clinical Applications

Cricothyrotomy Gray's Anatomy for Students: 536, 541, 543 Netter: 78, 83 Clinical Application Procedure creates an emergent airway through the cricothyroid membrane. Anatomic Landmarks ( Figs. VIII.1 and VIII.2 ) Palpation of midline structures Hyoid cartilage Thyroid cartilage Cricoid cartilage Skin/subcutaneous tissue Cricothyroid arteries and small veins (may traverse the cricothyroid membrane) Cricothyroid membrane Tracheal Intubation Gray's Anatomy for Students: 552, 553, 560 Netter: 68, 75,…