Information for consent in Ear Nose and Throat surgery

January 17, 2011 at 10:19 am | Posted in ent, nose, surgery, throat | Leave a comment

Information for consent in ear, nose and throat surgery prepared by HK College of Otorhinolaryngologist

DISCLAIMER
The material contained in these information sheets for ENT operations is
intended for physician reference and patient education. It is not intended for
third-party reimbursement or fiscal consideration. While every effort has been
made to ensure their accuracy, considering the possibility of unavoidable human
errors or progress in medical knowledge, the Hong Kong College of
Otorhinolaryngologists and the authors of the information sheets will not assume
any responsibility or liability for any injury and/or damage to persons or property
arising out of or related to any use of or reliance on the material in whole or in
part contained in this publication, and all persons using or relying on such
materials must exercise their own discretion.
Information for Consent
Adenoidectomy 腺樣體切除
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Removal of adenoid (enlarged lymphoid tissue located at nasopharynx, the back of the nose)
切除腺樣體(位於鼻咽/鼻孔後, 肥大的淋巴組織)
􀂃 Indications 適合病症
􀂉 1. Nasal airway obstruction
鼻塞
􀂉 2. Obstructive sleep apnea syndrome(OSAS) / Snoring
阻塞性睡眠窒息綜合症或鼻鼾症
􀂉 3. Otitis media with effusion
滲出性中耳炎
􀂉 4. Recurrent acute otitis media
復發性急性中耳炎
􀂉 5. Chronic or recurrent rhinosinusitis
慢性或復發性鼻竇炎
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Reduce nasal airway obstruction
減輕鼻塞
􀂉 2. Reduce snoring and sleep apnea
減輕打鼻鼾及睡眠窒息
􀂉 3. Relieve otitis media with effusion
解除中耳積液
􀂉 4. Reduce recurrent acute otitis media
減少急性中耳炎復發
􀂉 5. Reduce chronic or recurrent rhinosinusitis
減少慢性鼻竇炎復發
􀂉 6. There is chance of incomplete relief of symptoms and recurrence
有可能不會完全減輕症狀和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Nasal problems, snoring, sleep apnea and ear problems caused by obstruction other than adenoid
enlargement
並非因腺樣體肥大所引致的鼻腔、 打鼻鼾、 睡眠窒息和耳部問題
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Infection
感染
􀂉 3. Trauma to oral and nasal tissue
口鼻組織損傷
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Eustachian tube injury and stenosis causing otitis media with effusion, tinnitus and hearing loss
咽鼓管損傷,引致滲出性中耳炎、 耳鳴、 聽力下降
􀂉 2. Velopharyngeal incompetence causing voice change and fluid regurgitation on eating and drinking
腭咽閉合不良,引致發音改變、 進食和喝水時液體返嗆
􀂉 3. Nasopharyngeal stenosis causing obstruction of nasal breathing, snoring, sleep apnea, voice change
鼻咽狹窄,引致鼻塞、打鼻鼾、睡眠窒息、發音改變
􀂉 4. Voice change
聲音改變
􀂉 5. Temporomandibular joint injury causing pain, subluxation and trismus
顳頜關節損傷,引致疼痛、 半脫臼和 牙關緊閉
􀂉 6. Teeth injury causing fracture, loosening and pain
牙齒損傷,引致斷裂、 脫落和疼痛
􀂉 7. Cervical spine injury causing neck pain, decreased range of movement, sensory and motor nerve
deficit
頸椎損傷,引致頸痛、 活動減退、 感覺減低和運動神經損傷
􀂉 8. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Medical treatment
藥物治療
􀂉 2. Expectant treatment
觀察病情進展, 再作打算
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Persistent symptoms
症狀繼續存在
Information for Consent
Endoscopic Nasal and Sinus Surgery 鼻及鼻竇內窺鏡手術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Remove disease in the nose and sinuses to obtain drainage of paranasal sinuses by endoscopic
approach
通過內窺鏡,去除鼻及鼻竇疾病, 建立鼻竇引流
􀂃 Indications 適合病症
􀂉 1. Rhinosinusitis
鼻竇炎
􀂉 2. Nasal polyposis
鼻息肉
􀂉 3. Sinonasal tumors
鼻或鼻竇腫瘤
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Improve nasal symptoms such as obstruction, post-nasal dripping, facial pain, headache etc
改善鼻塞、 後鼻漏、 面部疼痛、 頭痛等問題
􀂉 2. Prevent complications of rhinosinusitis
預防併發症
􀂉 3. Remove tumor
摘除腫瘤
􀂉 4. There is chance of incomplete relief of symptoms and recurrence
可能不會完全減輕症狀和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Allergic symptoms such as itchiness, running nose, sneezing
其它過敏症狀:噴嚏、 鼻癢、 流鼻水
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Nasal bleeding
鼻膜出血
􀂉 2. Infection
感染
􀂉 3. Synechia
鼻腔粘連
􀂉 4. Recurrence of the disease
復發
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Severe bleeding due to injury of internal carotid artery, anterior and posterior ethmoidal arteries,
sphenopalatine artery
損傷頸內動脈、籂前後動脈和蝶腭動脈,引致大出血
􀂉 2. Eye injury including bruising, emphysema, orbital haematoma / abscess, visual loss, diplopia
眼損傷,包括眶周淤血、 眼球血腫或 膿腫、 失明、 重影
􀂉 3. Nasolacrimal duct injury leading to epiphora
淚管損傷,引致流淚
􀂉 4. Intra-cranial injury including CSF leak, meningitis, brain abscess, pneumocephalocele
腦損傷,包括腦髓液鼻漏、 腦膜炎、 腦膿腫、 腦氣腫
􀂉 5. Mucocele
粘液囊腫
􀂉 6. Voice change
聲音改變
􀂉 7. Transient or permanent loss of smell sensation
暫時或永久失去嗅覺
􀂉 8. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Steroid
激素
􀂉 2. Antibiotic to treat infection
抗生素治療感染
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Persistence or progression of nasal symptoms
症狀持續或加重
􀂉 2. Complication of sinusitis
鼻竇炎併發症
Information for Consent
Mastoidectomy 乳突切除術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Removal of disease in middle ear structure and mastoid air cells
切除中耳及乳突氣房病灶
􀂃 Indications 適合病症
􀂉 1. Cholesteatoma
膽脂瘤
􀂉 2. Acute mastoiditis
急性乳突炎
􀂉 3. Chronic suppurative otitis media (CSOM) and chronic mastoiditis
慢性化膿性中耳炎和乳突炎
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. To remove cholesteatoma
清除膽脂瘤
􀂉 2. To treat middle ear and mastoid infection
處理中耳和乳突感染
􀂉 3. There is chance of incomplete relief of symptoms and recurrence
有可能不會完全減輕症狀和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Tinnitus
耳鳴
􀂉 2. Dizziness
暈眩
􀂉 3. Hearing loss
弱聽
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Recurrence / residual disease
復發或 殘留
􀂉 2. Infection
感染
􀂉 3. Bleeding
出血
􀂉 4. Worsening of conductive hearing loss
傳導性弱聽加重
􀂉 5. Taste loss or disturbances
味覺失去或紊亂
􀂉 6. Allergic reaction to ear packing
對耳道塡塞物過敏
􀂉 7. Vertigo
暈眩
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Facial nerve injury
面癱
􀂉 2. Partial to total sensory hearing loss
失去部份或全部聽力
􀂉 3. Ear canal stenosis
耳道狹窄
􀂉 4. Pinna deformity
耳廓變形
􀂉 5. Intracranial injury causing intracranial infection and bleeding
顱內損傷,導致感染和出血
􀂉 6. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Regular aural toilet and medical treatment
定期耳道清潔和藥物治療
􀂉 2. Antibiotics ear drops
抗菌素滴耳
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Progression of disease with complications
疾病惡化和出現併發症
Information for Consent
Direct Laryngoscopy(DL) / Microlaryngoscopy(ML) 直接喉鏡 / 顯微喉鏡
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Examination of the larynx and adjacent areas
檢查喉及鄰近組織
􀂉 2. Biopsy or excision of suspicious lesions
活組織檢查
􀂉 3. Provision of access for other throat and laryngeal procedure
透過喉鏡進行其它手術
􀂃 Indications 適合病症
􀂉 1. Lesions in the larynx and related area
喉及相關區域病變
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Improve the voice quality
改善發音
􀂉 2. Relieve airway obstruction
解除氣道阻塞
􀂉 3. Obtain biopsy for histology
活組織檢查
􀂉 4. Excise lesion in selected cases
切除病變
􀂉 5. There is chance of incomplete removal of diseases and recurrence
有可能不能全部清除病灶和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Functional voice disorders
功能性發音病變
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Pain
疼痛
􀂉 3. Infection
感染
􀂉 4. Trauma to oral tissue
口咽組織損傷
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Teeth injury causing loosening, fracture and pain
牙齒脫落、 裂傷、 疼痛
􀂉 2. Temporomandibular joint injury causing pain, trismus and subluxation
顳頜關節損傷,引致疼痛、 半脫臼和 牙關緊閉
􀂉 3. Voice changes
聲音改變
􀂉 4. Upper airway obstruction
上呼吸道阻塞
􀂉 5. Postoperative pulmonary edema
術後肺水腫
􀂉 6. Cervical spine injury
頸椎損傷
􀂉 7. Loss of taste ( temporary or permanent)
失去味覺(暫時或 永久)
􀂉 8. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Expectant treatment
觀察病情進展, 再作打算
􀂉 2. Medical treatment
藥物治療
􀂉 3. Speech therapy
語言治療
􀂉 4. Radiotherapy / Chemotherapy in malignant condition
放射治療或化療 (惡性腫瘤)
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. No histological diagnosis
無病理診斷
􀂉 2. Progression of disease
病情惡化
Information for Consent
Myringotomy +/- Ventilation Tube Insertion 鼓膜切開術+/- 置管
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的健
康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. To make a hole in the eardrum (myringotomy)
耳膜開孔
􀂉 2. Placement of a ventilation tube through the eardrum
置管
􀂃 Indications 適合病症
􀂉 1. Secretory otitis media
分泌性(滲出性)中耳炎
􀂉 2. Eustachian tube dysfunction
咽鼓管阻塞
􀂉 3. Acute otitis media
急性中耳炎
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. To normalize the middle ear pressure
恢復中耳壓力
􀂉 2. To drain the middle ear
中耳引流
􀂉 3. Hearing improvement
改善聽力
􀂉 4. There is chance of incomplete relief of symptoms and recurrence after extrusion of the grommet
有可能置管排出後症狀不能完全緩解和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Tinnitus
耳鳴
􀂉 2. Dizziness
頭暈
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Recurrence
復發
􀂉 2. Infection
感染
􀂉 3. Bleeding
出血
􀂉 4. Residual ear drum perforation
耳膜穿孔
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Hearing loss
聽力減退
􀂉 2. Vertigo
暈眩
􀂉 3. Facial nerve damage
面神經損傷
􀂉 4. Dislodgement of ventilation tube into middle ear
置管脫入中耳
􀂉 5. Implantation Cholesteatoma
植入性膽脂瘤
􀂉 6. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Medical treatment
藥物治療
􀂉 2. Hearing aid
助聽器
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Persistent hearing loss
永久聽力下降
􀂉 2. Progression of infection with complications
感染惡化引致併發症
Information for Consent
Tympanoplasty 鼓室成型術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的健
康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Repair of perforated eardrum (myringoplasty)
修補耳膜
􀂉 2. Repair of ossicular chain (ossiculoplasty)
重建聽骨
􀂃 Indications 適合病症
􀂉 1. Perforated eardrum
耳膜穿孔
􀂉 2. Control or prevent ear infection
控制或預防中耳感染
􀂉 3. Hearing loss
弱聽
􀂉 4. There is chance of incomplete relief of symptoms and recurrence
有可能不會完全減輕症狀和有可能復發
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Intact eardrum (85% success rate)
完整鼓膜 (成功率85%)
􀂉 2. Control or prevent ear infection
控制或預防中耳發炎
􀂉 3. Hearing improvement
改善聽力
􀂉 4. There is chance of incomplete relief of symptoms and recurrence
有可能不會完全改善症狀和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Tinnitus
耳鳴
􀂉 2. Dizziness
頭暈
􀂉 3. Sensorineural hearing loss
感音神經性聽力下降
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Allergic reaction to ear packing
對耳道填塞物過敏
􀂉 2. Infection
感染
􀂉 3. Bleeding
出血
􀂉 4. Loss of taste sensation
失去味覺
􀂉 5. Vertigo
暈眩
􀂉 6. Recurrence of ear infection
感染復發
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Hearing impairment, total deafness can occur rarely
聽力減退,偶爾導致全聾
􀂉 2. Facial nerve damage
面神經損傷
􀂉 3. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Water precaution
耳道禁水
􀂉 2. Eardrops or systemic antibiotics
滴耳藥水或 抗生素
􀂉 3. Hearing aid
助聽器
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Recurrent infection and ear discharge with rare but serious complications
嚴重併發症
􀂉 2. Hearing impairment
聽力損害
Information for Consent
Neck Dissection 頸清掃
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Excision of all or part of the neck lymph nodes and adjacent structures
切除全部或部份頸淋巴結和鄰近組織
􀂃 Indications 適合病症
􀂉 1. Confirmed neck lymph node metastasis
明確的頸淋巴轉移
􀂉 2. Suspected neck lymph node metastasis
可疑的頸淋巴轉移
􀂉 3. As a neck staging procedure
頸淋巴轉移評估
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Complete removal of the neck metastasis
徹底清除頸淋巴轉移病灶
􀂉 2. Staging of neck metastasis for further treatment planning
評估頸淋巴擴散情況,對疾病作進一步治療計劃
􀂉 3. There is chance of incomplete removal of disease and recurrence
有可能不能全部清除病灶和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Extensive local disease involving vital structures
病灶累及重要結構
􀂉 2. Distant metastasis
遠處轉移
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Infection
感染
􀂉 3. Shoulder pain and weakness
肩痛和抬肩乏力
􀂉 4. Chyle leakage
乳糜漏
􀂉 5. Numbness of neck
頸麻痺
􀂉 6. Lymphedema
淋巴腫
􀂉 7. Hypertrophic scar or keloid formation
疤痕增生或疤痕瘤
􀂉 8. Cosmetic deformity
局部畸形
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Skin necrosis
皮膚壞死
􀂉 2. Nerve injury
神經損傷
􀂉 a. Facial nerve (VII) injury causing facial and mouth asymmetry
面神經損傷,引致面癱和 口角歪斜
􀂉 b. Vagus nerve (X) injury causing hoarseness of voice
迷走神經損傷,引致聲音嘶啞
􀂉 c. Accessory nerve (XI) injury causing shoulder muscle weakness, pain and stiffness
副神經損傷,引致抬肩無力、疼痛
􀂉 d. Hypoglossal nerve (XII) injury causing impairment of tongue movement and swallowing problem
舌下神經損傷,引致舌活動困難、 語言和吞嚥問題
􀂉 e. Brachial nerve injury causing upper limb paralysis
臂叢神經損傷,引致上肢麻痺和癱瘓
􀂉 f. Phrenic nerve injury causing breathing difficulty
膈神經損傷,引致呼吸困難
􀂉 g. Sympathetic nerve injury causing dropping of eyelid, dryness of face
交感神經損傷,引致眼皮下垂、 面部乾燥
􀂉 3. Increased intracranial pressure causing headache, vomiting, neurological deficit
顱內壓增高,引致頭痛、惡心、 嘔吐、 神經癱瘓
􀂉 4. Pneumothorax causing breathing difficulty
氣胸引致呼吸困難
􀂉 5. Cerebrovascular accident
腦血管意外
􀂉 6. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Radiotherapy
放射治療
􀂉 2. Chemotherapy
化療
􀂉 3. Observation
觀察
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Progression of disease
病情惡化
Information for Consent
Parotidectomy 腮腺切除術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. To remove part of or whole parotid gland
部份或全腮腺切除
􀂃 Indications 適合病症
􀂉 1. Parotid gland tumour (benign / malignant)
良性或惡性腮腺腫瘤
􀂉 2. Recurrent parotid infection
復發性腮腺炎
􀂉 3. Provide surgical access for other head and neck procedures
頭頸手術進路
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Removal of parotid gland tumor
切除腮腺腫瘤
􀂉 2. Prevent further parotid infection
預防腮腺感染
􀂉 3. There is chance of incomplete removal of disease and recurrence
有可能不能全部清除病灶和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Symptoms unrelated to parotid gland
非腮腺引致的病症
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding and hematoma
出血、 血腫
􀂉 2. Wound infection
傷口感染
􀂉 3. Numbness around earlobe
耳廓麻痺
􀂉 4. Frey’s Syndrome causing sweating during eating
Frey 氏綜合症,引致進食流汗
􀂉 5. Transient facial weakness
暫時面癱
􀂉 6. Hypertrophic scar or keloid formation
疤痕增生或疤痕瘤
􀂉 7. Cosmetic deformity
局部畸形
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Permanent facial weakness
永久面癱
􀂉 2. Recurrence
復發
􀂉 3. Salivary fistula
唾液腺漏
􀂉 4. Skin necrosis
皮膚壞死
􀂉 5. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Follow up with observation for benign lesion
觀察良性病變
􀂉 2. Radiotherapy for malignant lesion
放射治療惡性腫瘤
􀂉 3. Antibiotic to treat infection
抗生素醫治感染
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Tumour progression
腫瘤惡化
􀂉 2. Recurrent infection
感染復發
Information for Consent
Septoplasty / Submucosal Resection of Septum (SMR) 鼻中隔成型術/粘膜下隔切除術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的健
康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. To straighten the deviated nasal septum
矯正偏曲的鼻中隔
􀂃 Indications 適合病症
􀂉 1. Nasal obstruction attributed by a deviated nasal septum
鼻中隔偏曲引起的鼻塞
􀂉 2. Obstruction of sinus opening leading to sinusitis
鼻竇竇口引流阻塞導致的鼻竇炎
􀂉 3. Epistaxis
鼻出血
􀂉 4. Septal spur headache
鼻中隔引致的頭痛
􀂉 5. Provide exposure for other nasal surgery
其它鼻手術進路
􀂉 6. Deviated nose attributed by deviated nasal septum
鼻中隔偏曲,引致的歪鼻畸形
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Reduce nasal obstruction
減輕鼻塞
􀂉 2. Reduce obstruction of sinus opening leading to sinusitis
減輕竇口阻塞
􀂉 3. Reduce epistaxis
減少鼻出血
􀂉 4. Reduce septal spur headache
緩解鼻中隔導致的頭痛
􀂉 5. Improve nasal deformity attributed by deviated nasal septum
改善歪鼻畸形
􀂉 6. There is chance of incomplete relief of deviation and recurrence
有可能不能全部清除病灶和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Nasal obstruction not chiefly caused by deviated nasal septum
非鼻中隔偏曲導致的鼻塞
􀂉 2. Nasal symptoms due to allergic rhinitis including running nose, itchiness, sneezing, postnasal drip
過敏性鼻炎導致的症狀:鼻癢、 噴嚏、 後鼻漏
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Persistent nasal obstruction
鼻塞
􀂉 3. Infection
感染
􀂉 4. Nasal adhesion
鼻腔黏連
􀂉 5. Septal haematoma
鼻中隔血腫
􀂉 6. Septal perforation
鼻中隔穿孔
􀂃 Uncommon but serious complications (<1% risk) 嚴重但不常見併發症
􀂉 1. Saddle nose deformity / columellar retraction
鼻樑塌陷
􀂉 2. Loss of smell sensation
失去嗅覺
􀂉 3. Cerebrospinal fluid rhinorrhoea
腦髓液鼻漏
􀂉 4. Toxic shock syndrome
中毒性休克
􀂉 5. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Medical treatment
藥物治療
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Persistent nasal obstruction
持續鼻塞
􀂉 2. Sinusitis and its complications
鼻竇炎及併發症
􀂉 3. Recurrent epistaxis
復發性鼻出血
􀂉 4. Persistent headache
持續頭痛
􀂉 5. Persistent nasal deformity
持續鼻畸形
Information for Consent
Stapedectomy 鐙骨切除術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Removal of the fixed stapes bone and replacement with an artificial prosthesis
切除固定鐙骨 及 人工鐙骨植入
􀂃 Indications 適合病症
􀂉 1. Otosclerosis with conductive hearing loss
耳硬化症
􀂉 2. Other causes of stapes fixation with conductive hearing loss
其它病變引致鐙骨固定的傳導性耳聾
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Hearing improvement
改善聽力
􀂉 2. There is chance of residual hearing loss and recurrence after initial improvement
有可能不能全部清除病灶和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Tinnitus
耳鳴
􀂉 2. Dizziness
頭暈
􀂉 3. Sensorineural hearing loss
感音神經性耳聾
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Allergic reaction to ear packing
對耳道填塞物過敏
􀂉 2. Infection
感染
􀂉 3. Bleeding
出血
􀂉 4. Taste loss or disturbance
味覺失去或紊亂
􀂉 5. Tinnitus
耳鳴
􀂉 6. Vertigo
暈眩
􀂉 7. Hearing impairment
聽力損害
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Total deafness
全聾
􀂉 2. Eardrum perforation
耳膜穿孔
􀂉 3. Facial nerve damage causing facial paralysis
面神經損傷,引致面癱
􀂉 4. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Observation
觀察病情進展, 再作打算
􀂉 2. Hearing aid
助聽器
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Progressive hearing loss
聽力繼續下降
Information for Consent
Tonsillectomy 扁桃體切除術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Excision of the tonsils
切除扁桃體
􀂃 Indications 適合病症
􀂉 1. Recurrent/Chronic tonsillitis
復發性或慢性扁桃體炎
􀂉 2. Peritonsillar abscess
扁桃體周圍膿腫
􀂉 3. Obstructive sleep apnea syndrome(OSAS) / Snoring
阻塞性睡眠窒息綜合症或鼻鼾症
􀂉 4. Biopsy for histological diagnosis
活組織檢查
􀂉 5. Tonsillar malignancy
扁桃體惡性腫瘤
􀂉 6. Provide exposure for other head and neck surgery
手術進路
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Reduce throat infections
減少咽喉感染
􀂉 2. Reduce sleep apnea / snoring
減輕睡眠窒息 或 打鼻鼾
􀂉 3. Provide histological diagnosis
病理診斷
􀂉 4. There is chance of incomplete removal of disease and recurrence after initial improvement
有可能症狀不能全部清除和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Throat problem not attributed by the tonsils
非扁桃體引致的咽喉問題
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Pain
疼痛
􀂉 3. Infection
感染
􀂉 4. Local trauma to oral tissues
口腔局部損傷
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Teeth injury
牙齒損傷
􀂉 2. Jaw injury
下頷損傷
􀂉 3. Voice changes
聲音改變
􀂉 4. Upper airway obstruction
上氣道阻塞
􀂉 5. Postoperative pulmonary edema
術後肺水腫
􀂉 6. Cervical spine injury
頸椎損傷
􀂉 7. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Antibiotic to treat infection
抗生素治療感染
􀂉 2. Nasal continuous positive airway pressure (CPAP) device for OSAS
持續正壓呼吸機治療阻塞性睡眠窒息綜合症
􀂉 3. Radiotherapy / Chemotherapy for malignancy
放射治療或化療治療惡性腫瘤
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Recurrent tonsillitis or peritonsillar abscess and its complications
扁桃體炎或扁桃體周圍膿腫復發和出現併發症
􀂉 2. Complications of untreated OSAS
阻塞性睡眠窒息綜合症的併發症
􀂉 3. No histological diagnosis for suspected tonsillar tumour
不能準確診斷腫瘤
Information for Consent
Total Laryngectomy 全喉切除術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. To excise the whole larynx and create a new permanent tracheotomy with loss of natural voice
全喉切除, 氣管永久造口,並 失去正常發聲功能
􀂃 Indications 適合病症
􀂉 1. Malignant tumor involving the larynx
喉惡性腫瘤
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Complete removal of malignant tumor involving the larynx
切除腫瘤
􀂉 2. There is chance of incomplete removal of disease and recurrence
有可能不能全部清除腫瘤和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Tumor extends beyond the confine of the larynx
腫瘤超出喉範圍
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Infection
感染
􀂉 3. Pharyngocutaneous fistula
咽瘘(漏)
􀂉 4. Tracheostome stenosis causing breathing difficulty and requirement of stent or revision surgery
氣管造口狹窄,引致呼吸困難,而需要氣管套管或手術修正
􀂉 5. Loss of power to lift up heavy weight
失去舉重力
􀂉 6. Pharyngeal stenosis causing dysphagia
咽狹窄,引致吞嚥困難
􀂉 7. Thyroid insufficiency causing lethargy, cold intolerance, poor appetite, weight gain, hypotension,
heart failure, arrhythmia requiring life long replacement medication
甲狀腺功能減退,引致需要長期替代藥物治療
􀂉 8. Parathyroid insufficiency causing muscle cramp requiring life long replacement medication
甲狀旁腺功能減退,引致肌肉痙攣,需要長期替代藥物治療
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Pneumothorax
氣胸
􀂉 2. Skin necrosis
皮膚壞死
􀂉 3. Nerve injury
神經損傷
􀂉 a. Hypoglossal nerve (XII) injury causing impairment of tongue movement and swallowing problem
舌下神經損傷,引致舌活動困難、 語言和吞嚥問題
􀂉 b. Phrenic nerve injury causing breathing difficulty
膈神經損傷,引致呼吸困難
􀂉 c. Sympathetic nerve injury causing dropping of eyelid, dryness of face
交感神經損傷,引致眼皮下垂、 面部乾燥
􀂉 4. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Radiotherapy
放射治療
􀂉 2. Chemotherapy
化療
􀂉 3. Symptomatic palliative treatment
舒緩治療
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Progression of tumor and death
腫瘤惡化及死亡
Information for Consent
Tracheostomy 氣管切開術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Tracheostomy is an operation in which an opening is made through the neck skin into the trachea
切開頸部皮膚氣管造口
􀂉 2. A tube is inserted into the opening, through which breathing can continue
氣管套插入, 維持呼吸
􀂃 Indications 適合病症
􀂉 1. Upper airway obstruction
上呼吸道阻塞
􀂉 2. Prolonged endotracheal intubation
長時間的氣管插管
􀂉 3. Aspiration pneumonia
吸入性肺炎
􀂉 4. Airway protection
保護氣道
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Relief of upper airway obstruction and protection of airway
解除上呼吸道阻塞
􀂉 2. A tube is kept in the neck for breathing until normal airway is restored
氣管套管留置,直到正常氣道恢復通暢
􀂉 3. There is chance of failure to relieve problems and recurrence
有可能不能解決問題和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Lower airway obstruction
下氣道阻塞
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
.
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Infection
感染
􀂉 3. Swallowing problem
吞嚥困難
􀂉 4. Speech problem
語言問題
􀂉 5. Tracheostomy tube blockage and dislodgement causing asphyxia
套管阻塞或移位, 引致呼吸困難
􀂉 6. Surgical emphysema
皮下氣腫
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Apnea
呼吸暫停
􀂉 2. Tracheal stenosis
氣管狹窄
􀂉 3. Injury to other neck structures
其它頸部損傷
􀂉 4. Pneumomediastinum and pneumothorax
氣胸
􀂉 5. Tracheocutaneous fistula
皮氣管漏
􀂉 6. Erosion into large vessels causing fatal bleeding
大血管損傷,導致致命性出血
􀂉 7. Erosion into esophagus causing aspiration
損傷食道
􀂉 8. Failed weaning of tracheostomy
拔管困難 (不能拔管)
􀂉 9. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Endotracheal intubation
氣管插管
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Airway obstruction and death
氣管阻塞及死亡
􀂉 2. Prolonged intubation causing injury to trachea with resultant stenosis
長期插管損傷,引致氣管狹窄
􀂉 3. Aspiration and recurrent pneumonia
吸入性肺炎
Information for Consent
Inferior Turbinate Reduction 下鼻甲減容術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Transnasal resection of inferior turbinates
切除下鼻甲
􀂃 Indications 適合病症
􀂉 1. Hypertrophic inferior turbinates causing nasal obstruction
下鼻甲肥大引致的鼻塞
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Reduce nasal obstruction
緩解鼻塞
􀂉 2. There is chance of incomplete relief of nasal obstruction and recurrence
有可能不會完全改善鼻塞和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Nasal obstruction not chiefly caused by hypertrophic inferior turbinates
非下鼻甲肥厚引致的鼻塞
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
.
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Bleeding
出血
􀂉 2. Persistent nasal obstruction
持續鼻塞
􀂉 3. Infection
感染
􀂉 4. Intranasal adhesion
鼻腔粘連
􀂉 5. Crusting (transient)
暫時痂皮
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Atrophic rhinitis
萎縮性鼻炎
􀂉 2. Injury to Eustachian tube
咽鼓管損傷
􀂉 3. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Medical treatment
藥物治療
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Persistent nasal obstruction
持續鼻塞
Information for Consent
Uvulopalatopharyngoplasty (UPPP) / Laser-assisted Uvuloplasty (LAUP)
垂腭咽成型術 / 激光輔助腭咽成型術
version: 2005-07
(The fact sheet contains important information about the surgery / procedure. You should read it well before this
surgery / procedure. However, this information does not take the place of discussions with your healthcare
professional and / or clinicians regarding your health condition. Since it has not included all the information about
such surgery / procedure, please consult your doctor or health care professional if you have any questions.
本單張載有本手術的重要資料,故應於接受手術前細閱。不過,細閱本單張全部內容並不表示你毋須與醫生就你的
健康狀況有關療程進行商討。本單張並未盡列此手術所有資料,如你對此手術有任何疑問,應聯絡醫生。)
􀂃 Nature of procedures 手術性質
􀂉 1. Reduction/Resection of soft palate and uvula; plus resection of tonsils (UPPP)
軟腭 及 扁桃體切除
􀂉 2. Laser surgery on soft palate and uvula (LAUP)
激光手術輔助腭咽成型
􀂃 Indications 適合病症
􀂉 1. Obstructive sleep apnea syndrome (OSAS)
阻塞性睡眠窒息綜合症
􀂉 2. Snoring
鼻鼾症
􀂃 Intended benefits and expected outcome 預期結果
􀂉 1. Reduce sleep apnea
緩解睡眠窒息
􀂉 2. Reduce snoring
緩解打鼻鼾
􀂉 3. There is chance of incomplete relief of symptoms or recurrence after initial improvement
有可能不會完全緩解病灶和有可能復發
􀂃 Conditions that would not be benefited by the procedure 手術不能解決的問題
􀂉 1. Airway obstruction at levels other than oropharynx
非口咽狹窄引致的氣道阻塞
􀂃 Risk of side effects and complications 副作用和併發症風險
􀂉 1. There are always certain side effects and risks of complications of the procedure
手術有一些副作用和併發症風險
􀂉 2. Medical staff will take every preventive measures to reduce their likelihood
醫務人員將盡力減少副作用和併發症風險
.
􀂃 Common side effects and complications 常見副作用和併發症 (≧1% risk/風險)
􀂉 1. Pain
疼痛
􀂉 2. Bleeding
出血
􀂉 3. Throat discomfort and post-nasal dripping sensation
喉不適和後鼻漏
􀂉 4. Voice change
聲音改變
􀂉 5. Infection
感染
􀂉 6. Risk of laser
激光的危險
􀂃 Uncommon but serious side effects and complications 不常見但嚴重副作用和併發症(<1% risk/風險)
􀂉 1. Velopharyngeal insufficiencies causing regurgitation of food and water, and voice change
腭咽閉合不良,引致進食和喝水時液體返嗆、 發音改變
􀂉 2. Pharyngeal stenosis causing breathing difficulty, snoring, sleep apnea and voice change
咽狹引致呼吸困難、 打鼻鼾、 睡眠窒息和發音改變
􀂉 3. Loss of taste (temporary or permanent)
失去味覺 (暫時或 永久)
􀂉 4. Airway obstruction and respiratory distress
氣道阻塞和呼吸困難
􀂉 5. Death due to serious surgical and anaesthetic complications
由於手術或麻醉的嚴重併發症引致死亡
􀂃 Information of available alternative treatments 其它治療方法
􀂉 1. Nasal continuous positive airway pressure (CPAP) device
持續正壓呼吸
􀂉 2. Oral retaining device / dental appliances
口腔或 齒科裝置
􀂉 3. Other palatal procedure
其它腭手術
􀂃 Consequences of no treatment 不治療的後果
􀂉 1. Persistent or progression of snoring
鼻鼾聲持續存在
􀂉 2. Risk of complications of obstructive sleep apnea
阻塞性睡眠窒息綜合症的併發症

Upper airway obstruction

November 13, 2008 at 8:23 am | Posted in ent, medicine | Leave a comment
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Upper airway obstruction

Gavin Joynt http://www.aic.cuhk.edu.hk/web8/upper_airway_obstruction.htm

Pathophysiology

– obstruction is likely to occur at sites of anatomic narrowing such as the hypopharynx at the base of the tongue and the false and true vocal cords at the laryngeal opening.
– sites of airway obstruction are referred to as supraglottic (above the true cords), intraglottic (involving the true vocal cords) or infraglottic (below the true cords and above the carina)

– can also be divided into intrathoracic and extrathoracic portions: behave differently during inspiration and expiration. The intrathoracic airway dilates during inspiration as it is exposed to outward force of negative intrapleural pressure. Positive intrapleural pressure during expiration causes compression and narrowing. The compliant extrathoracic airway, not exposed to intrapleural pressure, collapses during inspiration and increases in diameter during expiration.

Aetiology

Functional causes

  • CNS depression
  • Peripheral nervous system and neuromuscular abnormalities
    • – Recurrent laryngeal nerve interruption (postoperative, inflammatory, tumour infiltration)),
      – obstructive sleep apnoea
      – laryngospasm
      – myasthenia gravis
      – Guillain-Barre polyneuritis
      – hypocalcaemia (causing vocal cord spasm).
      – tetanus

Mechanical causes

  • Haemorrhage and haematoma
    • post operative
    • anticoagulation therapy
    • coagulopathy
  • Trauma
  • Burns
  • Neoplasm
    • pharyngeal, laryngeal and tracheobronchial carcinoma
    • vocal cord polyposis
  • Congenital
    • vascular rings
    • laryngeal webs, laryngocoele
  • Miscellaneous
    • crico-arytenoid arthritis
    • achalasia of the oesophagus
    • hysterical stridor
    • myxoedema

Clinical presentation

  • may be complete or partial
  • complete UAO: rapidly progressing series of events
    • patient is unable to breathe, speak, or cough and may hold the throat between the thumb and index finger (the universal choking sign)
    • anxious and agitated. Vigorous attempts at respiration with intercostal and supraclavicular retraction. Heart rate and blood pressure raised Patient becomes rapidly cyanosed
    • respiratory efforts diminish, loss of consciousness, bradycardia and hypotension
    • cardiac arrest
    • death is inevitable if the obstruction is not relieved within 2-5 minutes of the onset
  • partial UAO: stable, or progressive deterioration
    • signs and symptoms may be mild but as they worsen include coughing, inspiratory stridor, crowing or noisy respiration, dysphonia, aphonia, choking, drooling and gagging
    • dyspnoea, feeble cough, respiratory distress and signs of hypoxaemia and hypercarbia such as anxiety, confusion, lethargy and cyanosis may be present as the obstruction worsens
    • powerful inspiratory efforts against an obstruction may produce dermal ecchymoses and subcutaneous emphysema. Partial airway obstruction that is worsening should be aggressively managed and if rapidly progressing immediate preparation for treatment as complete obstruction should be made (see Figures 1 and 2)

In stable, non-progressing cases of partial obstruction specific diagnostic evaluation may be undertaken provided the patient is strictly observed for any signs of deterioration and facilities for skilled airway management are immediately available.

Special investigations

Laryngoscopy and bronchoscopy

  • indirect laryngoscopy in a stable, cooperative patient is useful in diagnosing foreign bodies, retropharyngeal or laryngeal masses and other glottic pathology. In skilled hands it is quick, simple and atraumatic.
  • flexible fibreoptic bronchoscopy or laryngoscopy is useful for both diagnosis and management of UAO. Advantages:
    • ability to directly see upper airway anatomy and function and make an accurate diagnosis
    • can be performed in emergency department without moving patient and risking complete obstruction in an inadequately staffed or poorly equipped area
    • spontaneously breathing, awake patient
    • if care is taken is atraumatic and should not worsen obstruction
    • definitive airway control can usually be achieved at conclusion of examination by railroading an endotracheal tube into trachea

Disadvantages: need for a skilled operator, cooperative patient
– difficult in presence of blood and secretions

  • direct laryngoscopy may be both diagnostic and therapeutic. Foreign bodies, blood, vomitus, and secretions can be suctioned or removed with forceps. Endotracheal intubation can be rapidly achieved under direct vision. Disadvantages:
    • necessity for good local analgesia (often difficult in the emergency setting) or general anaesthesia with the resultant risk that spontaneous breathing and airway control is completely lost
    • traumatic procedure and may lead to worsened swelling, bleeding and oedema.

Radiographic imaging

  • AP and lateral plain neck radiographs are useful to detect radiopaque foreign bodies, retropharyngeal masses and epiglottitis. Lateral view should be obtained during inspiration with the neck fully extended.)
  • CT: in stable patients the integrity of the thyroid, cricoid and arytenoid cartilages as well as the status of the airway lumen can be assessed
  • MRI has been used to image the upper airway but use in obstruction is unproved

Gas flow measurement

– flow volume measurement reveals characteristic patterns corresponding to different types and position of pathologic lesions

Management

  • reverse hypoxia:100% O2 or as close as possible
  • no single correct approach to the management
  • in difficult situations technique in which the physician has greatest skill and experience is usually the most appropriate

General measures

  • equipment: good suction, a choice of laryngoscopes, blades and endotracheal tubes, fibreoptic bronchoscope or laryngoscope, emergency drugs and equipment necessary for a surgical airway (cricothyroidotomy set, tracheostomy tray and pre-prepared circuit for trans tracheal jet ventilation).
  • IV access as soon as practicable.
  • continuous monitoring and observation with the most skilled personnel.
  • transport of patient before airway is secured should be carefully considered as it is difficult to provide safe conditions either during transport or in radiology suites

Principles of airway management techniques

Airway manoeuvres

  • try simple manoeuvres to open airway. Jaw thrust (triple airway manoeuver) is used when other methods have failed.
  • oropharyngeal airway or nasopharyngeal airway may be useful in the unconscious patient.
  • if the patient is not immediately intubated the coma position (semi-prone, slightly head down) should be used.

Endotracheal intubation

  • direct laryngoscopy and tracheal intubation is method of choice for the unconscious, apnoeic patient
  • awake fiberoptic intubation. Following are important in setting of acute UAO:
    • procedure should be clearly explained to reduce anxiety and improve cooperation.
    • good local anaesthesia is important.
    • phenylephrine (1-2%) or cocaine (2ml of 5% solution) decrease nasal bleeding
    • suction catheters (oro or nasopharyngeal) may improve success rates
    • suction port can be used to insufflate 100% oxygen. Also keeps the bronchoscope tip free of secretions.(25)
  • blind nasotracheal intubation is becoming a less attractive option in UAO.
  • retrograde tracheal intubation over a j-tip guidewire: less invasive alternative to cricothyroidotomy and transtracheal jet ventilation. Airway can be secured within five minutes. Can be achieved with minimal neck movement and is useful where fibreoptic bronchoscopy is not available, or difficult because of retropharyngeal secretions and blood. Relatively safe, simple and requires minimal operator skill

Surgical Airway

  • indicated when endotracheal intubation is not possible, or an unstable cervical spine is threatened by available airway techniques.
  • percutanous transtracheal jet ventilation using a large bore intravenous catheter inserted through the cricothyroid membrane
    • quick, simple, relatively safe, effective technique in situation where patient cannot be intubated or ventilated
    • quicker than cricothyroidotomy or tracheostomy
    • ventilation through an intravenous cannula with a standard bag valve resuscitator or anaesthesia circuit will be less than adequate
    • jet ventilation system and gas source of appropriate pressure (60 lbs/in2) should be immediately available
    • expiratory gases must be able to escape via the glottis and in cases of complete UAO the technique should be used with caution.
    • appropriate chest movement must be carefully observed during expiration
    • consequence of expiratory obstruction is severe and potentially fatal barotrauma.
  • cricothyroidotomy
    • reliable, safe, relatively easy way of providing an emergency airway
    • method of choice if complete UAO exists and expiration is unlikely to be possible via the glottis.
    • minimum internal diameter tube to allow adequate gas exchange (using supplemental O2): spontaneous breathing 3mm; ventilation with a bag valve resuscitator 2.5mm
    • diameter of the cricothyroid space is 9mm by 30mm and therefore a size 8.5 outer diameter tube should avoid complications such as laryngeal fracture and vocal cord damage. #4 Shiley tracheostomy tube has an internal diameter of 5mm and an outer diameter of 8.5mm and is therefore ideal. A standard 6-6.5 endotracheal tube could also be used.
    • commercially available percutanous tracheostomy sets (Cook) that meet above requirements are available.
    • complications (eg subglottic stenosis, thyroid fracture, haemorrhage and pneumothorax) uncommon.
  • emergency tracheostomy rarely required. Formal surgical tracheostomy under local anaesthesia may be a prudent approach under some controlled conditions

Common clinical conditions

Extrinsic airway compression

  • commonly due to haemorrhage, infections and tumours. Haematomas should be considered following trauma, neck surgery, central venous catheterization, as a complication of anticoagulation therapy and in patients with abnormal bleeding tendency.
  • haematomas following surgery should be immediately managed by suture removal and haematoma evacuation in an attempt to relieve the obstruction. If this fails an artificial airway should be immediately secured
    – in patients with coagulation abnormalities intubation is preferred over a surgical airway due to potential complications of bleeding. Most do not require surgical intervention and resolve spontaneously with conservative therapy – discontinuation of anticoagulants, vitamin K, fresh frozen plasma and coagulation factors. Use of prophylactic antibiotics is controversial

Retropharyngeal abscesses causing partial UAO

  • best managed by awake drainage under local anaesthesia
  • gentle fibreoptic examination and intubation, or direct laryngoscopy and intubation in lateral, head down position is favoured by some. Risks are related to inadvertent rupture of abscess with subsequent soiling and obstruction of airway.

Ludwig’s angina

  • mixed infection of floor of mouth.
  • inflammatory mass develops in space between tongue and the muscles and fascia of anterior neck
  • supraglottic airway is compressed and becomes narrowed
  • direct laryngoscopy is difficult as the tongue cannot be anteriorly displaced
  • awake fibreoptic bronchoscopy or a surgical airway are management options

Intrinsic airway compression

Inhalational injury

  • UAO from progressive supraglottic oedema which usually develops within 24 hours of injury
  • risk factors for severe oedema: increased size of cutaneous burns (>30-45%), rapid, vigorous intravenous fluid administration and evidence of facial and neck burns
  • patients in these categories should be intubated early and even prophylactically unless careful follow up, preferably with fibreoptic bronchoscopy and lung function testing, can be undertaken.
  • patients with stridor, hoarseness, or hypoxaemia should be immediately intubated by an appropriate method

Allergic manifestations

  • may be localized or part of a systemic anaphylactic reaction
  • in acute allergic laryngeal oedema, angioedema of the lips and supraglottis, glottis, and infraglottis results in airway obstruction
  • systemic reaction consists of a variable combination of urticaria (79%), bronchospasm (70%), shock, cardiovascular collapse and abdominal pain
  • common causative agents are Hymenoptera stings, shellfish ingestion and drugs
  • angiotensin converting enzyme inhibitor therapy related angioedema is becoming more common as the number of patients receiving this therapy increases
  • treatment consists of immediately ensuring an adequate airway and administration of oxygen, intravenous fluids, epinephrine, antihistamines and steroids:
Oxygen 100%
Intravenous fluid replacement
Epinephrine (1:10 000) or
Epinephrine (1:1000)
0.2-0.5 ml IV
0.3 ml SC
Diphenhydramine 50 mg IV/IM
Methylprednislone or
Hydrocortisone
125 mg IV
200 mg IV
Aminophylline 5.6 mg/kg over 30 min
  • as it is likely to recur, the exact nature of the event and agent or drugs responsible should always be thoroughly investigated and communicated to the patient prior to discharge

Hereditary angioedema (Quincke’s disease)

  • rare, inherited disorder of the complement system caused by either functionless or low levels of C1 esterase inhibitor
  • clinical manifestation is the occurrence of angioedema involving the deeper layers of skin and subcutaneous tissue in various locations, particularly the upper airway
  • precipitating causes include stress, pregnancy, physical exertion and especially localized trauma such as surgery (dental or maxillofacial) and laryngoscopy
  • management consists of establishing a secure airway and the infusion of fresh frozen plasma to replace the missing esterase inhibitor or administration of inhibitor
  • poor response to epinephrine, antihistamines, and steroids can be expected
  • danazol, anti-fibrinolytic agents(tranexamic acid) and fresh frozen plasma (2-4 units) can be used prophylactically if time permits

Complications

– post obstruction pulmonary oedema occurs in as many as 11% .

  • appears to be related to the markedly elevated intrathoracic pressure caused by forced inspiration against a closed upper airway, resulting in transudation of fluid from pulmonary capillaries to the interstitium
  • in addition to the decreased interstitial pressure, increased venous return to the right heart may increase pulmonary blood flow, further worsening oedema
  • hypoxia and the “hyperadrenergic state” may also affect capillary hydrostatic pressure
  • usually occurs within minutes after the relief of the obstruction but may be delayed up to 2.5 hours
  • management consists of supportive care and includes maintenance of airway patency, oxygen, diuretics, morphine, fluid restriction, CPAP. Ventilation with PEEP may be necessary in severe cases. Pulmonary capillary wedge pressure is usually normal and pulmonary artery flotation catheterization should be reserved only for complicated cases with severe underlying disease

Summary

Failure to treat acute UAO aggressively is associated with a worse outcome than over treatment. It is essential to have a plan of management which includes alternative approaches should the initial method fail. Emergency physicians should be proficient in all types of airway management, including the techniques required to secure a surgical airway. Difficult clinical problems may not present with a clear ” best approach”. In this situation management should be by those techniques in which the attending team has the greatest skills and experience.


© Gavin Joynt 1996

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