tailieunhanh - Surgical Atlas of pediatric otolaryngology - part 3

Nếu vị trí của một ghép dây thần kinh sural được dự đoán trước, cẳng chân, mắt cá chân, và bàn chân tương tự chuẩn bị. Một chiếc găng tay phẫu thuật được đặt trên các ngón chân, bàn chân và chân được bọc với một stockinette vô trùng và được đặt trên một tờ vô trùng. Một treo lên cực được sử dụng để che chân. | Facial Nerve Exploration and Repair 159 If placement of a sural nerve graft is anticipated the lower leg ankle and foot are similarly prepared. A surgical glove is placed over the toes and the foot and leg are draped with a sterile stockinette and placed on a sterile sheet. An extremity drape is used to cover the leg. A thyroid or a split sheet is used to cover the patient and to drape the entire surgical field. The scrub nurse stands next to the surgeon and in front of the back scrub table. Surgical loupes and the microscope should be available to help the surgeon locate and dissect along the nerve. Procedure Figure 7 18 overviews extratemporal exploration and repair for lesions. Figure 7 18 Extratemporal exploration and repair for parotid and nonparotid lesions. Make appropriate parotidectomy incision Elevate skin flap to expose parotid gland if indicated locate peripheral branches of facial nerve ị . Dissect sternocleidomastoid muscle locate great auricular nerve and digastric muscle dissect toward mastoid tip locate cartilage of ear canal dissect medially to facial nerve at stylomastoid foramen ị Retract parotid gland anteriorly to confinn facial nerve by locating bifurcation . r Incise parotid tissue lateral to facial nerve superior and inferior to tumor remove parotid tissue between branches of facial nerve excise pathology specimen For total parotidectomy elevate facial nerve and branches and remove deep lobe .i . . . Irrigate wound re-examine facial nerve for continuity place drains and sutures Apply antibiotic ointment and pressure dressing to incision 160 Surgical Atlas of Pediatric Otolaryngology No 1. Incision and exposure The proposed preauricular incision Figure 7 19 is marked with a surgical marker. In older children and adolescents the incision will be less noticeable if curved posteriorly to conform to the anatomic indentation just superior to the tragus inferior to the tragus or both. The incision continues just inferior to the earlobe and .