Extraoral Styloidectomy mayo stand and back table surgery setup

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setup author

Extraoral Styloidectomy surgery instruments

Cutting & Dissecting instruments

Tenotomy Scissor
Tenotomy Scissor
Molt Double-Ended Curette
Molt Double-Ended Curette

Grasping & Holding instruments

Debakey Forcep
Debakey Forcep
Hardy Non Stick Insulated Bipolar Bayonet Forceps
Hardy Non Stick Insulated Bipolar Bayonet Forceps
Schnidt Forceps
Schnidt Forceps
Gerald Debakey Tissue Forceps
Gerald Debakey Tissue Forceps

Misc instruments

Nerve Probe
Nerve Probe

Retracting & Exposing instruments

Freer Skin Hook
Freer Skin Hook
Cottle Double Ended Septum Elevator
Cottle Double Ended Septum Elevator
Weitlaner Retractor
Weitlaner Retractor
Obwegeser Tissue Retractor
Obwegeser Tissue Retractor

Suctioning instruments

Yankauer Suction
Yankauer Suction

Suturing & Stapling instruments

Castroviejo Needle Holder
Castroviejo Needle Holder
Mayo-Hegar Needle Holder
Mayo-Hegar Needle Holder

What to expect during Extraoral Styloidectomy

Additional Instruments/Equipment

  1. Lonestar Retractor 32.5cm x 18.3cm
  2. Blunt 12mm Lonestar Retractor Hooks
  3. Sonopet IQ w/ Disposable Tip
  4. Bovie
  5. Surgicel (hold)
  6. Nerve Stimulator Probe

Positioning

  • Supine, head turned 45° away from surgical side. Arms tucked at side. 

Drapes

  1. Sterile Towel—scrunched into ball to place under turned away head
  2. 4 Sterile Towels to square off surgical site
  3. 1010
  4. U-Drape (or Split Drape)
  5. 3/4 Sheet as needed for full coverage of pt/table

Suture

  1. Vicryl 4-0 PS2: skin
  2. Vicryl CR 3-0 SH: subq
  3. Silk 2-0 FS: suturing nerve stimulator electrodes in place
  4. Prolene 6-0 P3: as needed for vascular suturing, used with castroviejo

Blade

  • #15 blade on 3 knife handle

Dressings

  1. Mastisol
  2. Steri Strips

Purpose of Procedure

To remove a portion of an elongated styloid bone to decompress the jugular vein. Pre-operative symptoms may include neck/jaw pain, dizziness, globes, tinnitus, vision changes, headache.

Procedure Steps

  1. After patient has been anesthetized, prior to incision, the nerve monitoring rep will place the electrodes on the patient. The surgeon will then suture the oral probes in place with silk.
  2. After Timeout & draping, surgery begins.
  3. Incision site is marked w/ skin marker, followed by incision made 3cm below the mandibular angle.
  4. Skin hooks are used for initial retraction as the incision is deepened by bovie. Skin hooks are replaced with a weitlaner retractor.
  5. A tonsil (schnidt) & tenotomy scissor is used to gently undermine the tissue. Bipolar forceps are used as needed.
  6. The weitlaner is removed and replaced by the Lonestar Retractor with skin hooks. This is left throughout the surgery, but toe-in obewegser retractors are used in addition for extra exposure of anatomy as needed.
  7. Dissection is continued by use of tonsils and tenotomy scissors. If an enlarge lymph node is seen at level 2 or 3, it will be removed and sent to pathology.
  8. Once the styloid bone is reached, the cottle, molt, tonsil & tenotomy scissors are used to dissect around the styloid bone and ligaments.
  9. After enough exposure of the styloid is created, the Sonopet IQ  aids in resection of the bone. After completion, it is removed from the neck using a tonsil and sent for pathology.
  10. Closure is then performed: 3-0 Vicryl subq, 4-0 Vicryl on skin, followed by mastisol/steristrips.

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