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This chapter focuses on non-traumatic maxillary procedures and endoscopic maxillary sinus surgery. Successful surgery involves open dialog between the anesthesiologist, ENT surgeon, and at times the plastic surgeon. Salivary gland resection poses technical challenges to both the surgeon and the anesthesiologist. The anesthetic management of these procedures mainly involves preservation of motor function of the face. Salivary gland resection is an example of the integrated efforts of both surgeon and anesthesiologist. The chapter focuses on the surgery of the mandible and temporomandibular joint (TMJ). Surgery for the mandible can range from biopsy to radical mandibular resection. An example of an anesthetic management for reconstructive mandibular cancer surgery is discussed in the chapter. TMJ arthroscopy is an effective minimally invasive technique to reduce pain and improve the mandibular range of motion that can be done safely on an outpatient basis.
This chapter discusses the minimal synopsis of selected airway pathology in terms of associated anesthetic and airway implications. The case types covered are those where awake intubation by some means is often the method of choice. Epiglottitis can occur in adults too but the situation is less dreadful because the adult airway is larger. Retropharyngeal abscess formation may occur from bacterial infection of the retropharyngeal space secondary to tonsillar or dental infections. Airway tumors can be benign or malignant, but regardless of type, suffocation from airway obstruction is always a potential concern. Nasal polyps and polyps elsewhere in the airway can lead to partial or complete airway obstruction. Patients with laryngeal papillomatosis caused by a HPV infection may require frequent application of laser treatment for attempted eradication of the papillomas. Since Ludwig's angina is often associated with trismus, nasal fiberoptic intubation is frequently needed.
The paired parotid glands are the largest among the three major salivary glands in the human body. The parotid gland is encapsulated between the superficial and deep layers of the parotid gland fascia (PGF). This chapter discusses the surgical treatment and anesthesia of sialolithiasis. Airway management after parotidectomy with radical neck dissection can be a challenging situation due to aggravating factors like previous neck interventions, radiation therapy, large fluid shift, intraoperative airway manipulation, swollen tissue and residual anesthetic effect. Ductal stone formation and ductal stenosis are common causes of obstructive salivary diseases of the parotid glands. Sufficient anesthetic depth and patient immobility are usually achieved by a balanced anesthetic technique employing relatively large doses of opioid and inhalational agents. Light anesthesia and patient movement lead to serious complications, especially in the absence of neuromuscular blockade.
Anesthesia for Otolaryngologic Surgery offers a comprehensive synopsis of the anesthetic management options for otolaryngologic and bronchoscopic procedures. Authored by world authorities in the fields of anesthesiology and otolaryngology, both theoretical concepts and practical issues are addressed in detail, providing literature-based evidence wherever available and offering expert clinical opinion where rigorous scientific evidence is lacking. A full chapter is dedicated to every common surgical ENT procedure, as well as less common procedures such as face transplantation. Clinical chapters are enriched with case descriptions, making the text applicable to everyday practice. Chapters are also enhanced by numerous illustrations and recommended anesthetic management plans, as well as hints and tips that draw on the authors' extensive experience. Comprehensively reviewing the whole field, Anesthesia for Otolaryngologic Surgery is an invaluable resource for every clinician involved in the care of ENT surgical patients, including anesthesiologists, otolaryngologists and pulmonologists.