I need HELP

  1. We are going to start having an increase in craniotomy surgery according to an ENT that recently visited our unit and gave a quick run through of the 4 approaches he would be using.
    Problem #1 I can not remember the 4 approaches I beleive they are

    1. Frontal, either side the top front and into the orbit of one side
    2. Bi-frontal, the topfront and both orbit
    3. Lateral, a side entry around the orbit of that side
    I can not remember the 4th I believe he described going in from bellow by rotating the mandible out and away then going under the nasal passage, can anyone help me with the name of this entry?

    Problem #2 I need websites or even books I can look into for some help devising a teaching plan for an inservice on Nursing care for these surgeries.

    Any and all help is greatly appreciated. Thanks
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  2. 6 Comments

  3. by   CCU NRS
    Quote from CCU NRS
    We are going to start having an increase in craniotomy surgery according to an ENT that recently visited our unit and gave a quick run through of the 4 approaches he would be using.
    Problem #1 I can not remember the 4 approaches I beleive they are

    1. Frontal, either side the top front and into the orbit of one side
    2. Bi-frontal, the topfront and both orbit
    3. Lateral, a side entry around the orbit of that side
    I can not remember the 4th I believe he described going in from bellow by rotating the mandible out and away then going under the nasal passage, can anyone help me with the name of this entry?

    Problem #2 I need websites or even books I can look into for some help devising a teaching plan for an inservice on Nursing care for these surgeries.

    Any and all help is greatly appreciated. Thanks
    Bump HELP!
  4. by   NewZealandStudent
    hey just found quite a well explained example of a teaching plan on this website http://www.nsu.edu/nursing/formbook/...GUIDELINES.doc
    give it a go, its helped me out a bit!!!
    GOOD LUCK
  5. by   PJMommy
    "trans-sphenoid"?
  6. by   stevierae
    Quote from PJMommy
    "trans-sphenoid"?
    Transphenoidal. You will see this approach done for certain pituitary tumors--that is, a transphenoidal hypophysectomy, meaning removal of the pituitary gland.

    Now, if you have patients on your floor with acoustic neuromas, particularly medium-sized acoustic neuromas, you may also see a trans-labyrinthine approach--that is, from behind the ear, drilling through the mastoid and removing the inner ear structures. These operations, like transphenoidals, are generally done by a neurosurgeon and an ENT doc working as a team. I believe that this results in permanent deafness of that ear, but the other ear compensates for the hearing loss. The hole through the mastoid is usually patched with a fat graft taken from the patient's abdomen (autograft.)

    Large acoustics require more extensive drilling through the mastoid; thus more bone removal.
    Last edit by stevierae on May 31, '05
  7. by   suzanne4
    They normally do not need to move the mandible out of the way. They actually go in thru the nares and keep going. That is why you see the moutache dressings, the same that you see when a patient has a rhinoplasty.

    ENT doctors usually do not do that type of surgery. They normally do not do craniotomies or have anything to do with the brain. The only ENT doctors that do are "neuro-otologists" and they do primarily what is called skull-based surgery. Many times they work in conjunction with a neurosurgeon if their is an unusual approach called for.

    Give me an idea of what type of surgeries that he is actually going to be doing and I can send you a number of articles. I worked for quite some time on a neuro team in the OR in a major medical center. As well as with a head and neck team.
    Last edit by suzanne4 on May 31, '05
  8. by   stevierae
    Quote from suzanne4
    They normally do not need to move the mandible out of the way. They actually go in thru the nares and keep going. That is why you see the moutache dressings, the same that you see when a patient has a rhinoplasty.

    ENT doctors usually do not do that type of surgery. They normally do not do craniotomies or have anything to do with the brain. The only ENT doctors that do are "neuro-otologists" and they do primarily what is called skull-based surgery. Many times they work in conjunction with a neurosurgeon if their is an unusual approach called for.

    Give me an idea of what type of surgeries that he is actually going to be doing and I can send you a number of articles. I worked for quite some time on a neuro team in the OR in a major medical center. As well as with a head and neck team.
    Yeah, I was wondering about that description; I have scrubbed and circulated a fair number of transphenoidals, over the years but never seen anyone rotate the mandible out of the way--was curious if that was a new technique. Thanks, Suzanne.

    Wherever I've worked, though, ENTs and neurosurgeons did partner together on both acoustics and transphenoidals. Guess it just depends on the institution---all were teaching hospitals, with both ENT and neurosurgery residents.

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