SurgSpace / Specialties / Otolaryngology, Head & Neck
Otolaryngology, Head & Neck
Ear, nose, throat and the neck's compartments: the airway always first, the thyroid and the nerves that decide the voice, and the high-volume operations, tonsils, grommets, septum, whose small complication lists are learned precisely because the operations are so common.
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
A fixed laryngeal tumour with worsening stridor: anaesthesia doubts an intubation will pass. Attempt asleep intubation, or awake tracheostomy under local?
Awake tracheostomy
The airway secured below the obstruction while the patient maintains their own breathing: uncomfortable, unhurried, and safe precisely because nothing is burned before the airway is won.
Asleep intubation attempt
Defensible only with a favourable fibre-optic view and a double setup (surgeon scrubbed, neck prepped): induction removes the muscle tone holding a marginal airway open, and a failed attempt can close it for good.
The principle is bridges: never burn one you cannot rebuild. Induction trades the patient's own airway for a promise, and when the promise is doubtful, the awake technique keeps the patient breathing while the definitive airway is placed. This decision is made jointly, out loud, with plan B and C assigned before anyone starts.
Six hours after thyroidectomy: the neck is swelling, the patient anxious, voice changing, saturations still normal. Wait for theatre, or open the wound now?
Open at the bedside
Clips out, layers opened, haematoma released: the airway threat is pressure on laryngeal veins causing oedema, and decompression is the treatment that cannot wait for a porter.
Rapid transfer to theatre
Right when the patient is stable and theatre is genuinely immediate: with anaesthesia alongside and the bedside option still in hand at every corridor.
Normal saturations are the trap: the laryngeal oedema building behind a tense neck does not show on the monitor until the airway is nearly gone. The kit to open the wound lives at the bedside of every neck surgery patient, and knowing that is a covering doctor's competency, not trivia.
An anticoagulated patient still bleeding through an anterior pack: blood trickling down the posterior pharynx. Next rung?
Posterior packing and admission
Tamponade of the sphenopalatine territory: effective, unpleasant, and an admission with monitoring, since posterior packs in the frail carry real physiologic cost.
Definitive control: ligation or embolisation
Sphenopalatine artery ligation or radiologic embolisation for the bleed that defeats packing: earlier referral beats later heroics, especially on anticoagulation.
The ladder is climbed decisively, not lingered on: each failed rung is information that the bleeding point outranks the method. Blood behind an anterior pack means posterior source, and the anticoagulation conversation (hold, reverse, restart when) runs parallel to every rung.
The rotation
Your first day here
- Learn the airway questions before anything else: is it safe, how long will it stay safe, and who am I calling if the answer changes.
- Find the tracheostomy boxes and the bedside drill posters on your ward in the first hour: the blocked-tube sequence is knowledge you may spend within the week.
- Never examine a stridulous throat with a tongue depressor, and never lie that patient flat: the two prohibitions that buy time for the team to arrive.
- The neck-lump order is look, needle, image, then biopsy: know why an open biopsy first is the classic error and you understand the whole clinic.
- After thyroid surgery, the voice and the calcium are the two follow-up questions: ask them on every round.
- In clinic, ask to watch flexible nasendoscopy early: the specialty's examinations make sense once you have seen the larynx live.
Hub shaped by the Surgical Specialties Lead with the ENT reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.