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OCTOBER 2015 | The Surgical Technologist | 451 ments. The transmitter and CT images of the patient will be synchronized with the patient and projected onto the com- puter monitor. All pledgets will be removed from the nasal area and placed in the bupivacaine/EPI emesis basin. Many times septoplasty and bilateral turbinate reduc- tion will be performed in conjunction with endoscopic sinus surgery due to a deviated septum and enlarged turbinates which cause obstruction. A #15 blade will be used to incise the septum followed by a Cottle knife to elevate the lining of the septum. The surgical technologist will provide suc- tion using a Frazier suction tip. The surgeon will then take a swivel knife, Jensen Middleton forceps and Takahashi or Far- ris Smith forceps to remove any deformed cartilage from the septum. A camera will be employed to examine the middle meatus identifying the uncinate process, which is located along the wall of the maxillary sinus articulating with the ethmoid process. Sometimes, the uncinate will be removed with a microdebrider or trimmed using a 45-degree up-bit- ing through-cut forceps to open a pathway to the ethmoid sinus or ethmoid bulla as well as to provide easier access to the maxillary sinus. In this case, a bilateral middle meatal antrostomy, BMMA, is performed by first probing the area with an ostium seeker to find the natural sinus ostia of the maxillary sinus. A back biter forceps, Stammberger forceps or straight through-cuts will be placed in the sinus ostia and tissue will be removed to enlarge the opening. According to Dr Brennan Wood, Medical Director of Northeast Georgia Otolaryngology, “This connects the sinuses allowing them to communicate thus providing better drainage.” It is common that without this method, sinus surgery may fail. After a typical BMMA is performed, the lateral bound- ary of the sinus will be determined and the ethmoid sinus will be examined. Many times, however, once the uncinate has been removed, the surgeon has a clear pathway to the ethmoid for examination of any polyps or diseased portion of the sinus. This type of progression of treatment is strictly based on surgeon preference and type of case. From here an ethmoidectomy, sphenoidectomy and frontal sinusotomy may be performed. Using the IGS integrated with the micro- debrider, the location of the instrument is registered on the monitor in relation to the patient’s anatomy. This provides the surgeon with valuable information including the loca- tion of the eyes, skull base and optic nerve. In regard to the frontal sinus the introduction of a balloon to dilate the sinus may be used in lieu of a sinusotomy. Research studies conducted by Ron Van Tuyl, MD, of Piedmont Hospital have shown that the hybrid method using both the balloon system coupled with the microdebrider provides better post-operative results than either system alone. Polyps also may be removed using the microdebrid- er or up-biting Blakesley forceps. A standby long bi-polar forceps or a suction Bovie may be used for any excessive bleeding. When the turbinates of the nasal cavity are swollen, the surgeon will incise the middle turbinate using a #15 blade and employ a special microdebrider blade to create scaring on the inside of the middle turbinate and along the sep- tum. A Freer elevator or Boise elevator will be employed to press the middle turbinate against the septum. The goal will be to encourage the turbinate to heal to the septum in a manner called Bolgerization. Some ENT surgeons use EQUIPMENT & INSTRUMENTS System monitor and emitter Camera, lens, monitor and light source Straight shot microdebrider system with tracking blade system On stand-by: hydrodebrider system and electrosurgical unit Nasal tray and sinus tray System monitor and emitter Patient tracker Instrument tracker Electromagnetic balloon system SUPPLIES Basic ENT Pack Doyle splints, nasal packing, packing gel, hemostatic powder or propel stents Medications: Bupivacaine hydrochloride- and epinephrine-soaked pledgets, lidocaine epinephrine injection Suture Saline and sterile water System monitor and emitter Patient tracker Instrument tracker Electromagnetic balloon system