OSCE DISCUSSION GROUP

 FUGITA CLASSIFICATION OF OSAS (for dynamic MRI) –

 Type I – Oropharyngeal narrowing with normal palatal arch.

 Type II – Low palatal arch and large tongue
 Type IIa – Predominantly oropharynx with normal hypopharynx.
 Type IIb – Predominantly oropharynx with narrow hypopharynx.
 Type III – Normal oropharynx with compromised hypopharynx with large or
posterior tongue, lateral wall bulge, hypertrophic lingual tonsils and atonic
supraglottis.
 Other classifications include Friedman and Moore classification.
 CYSTIC FIBROSIS – The deletion of single phenylalanine residue at
position 508 of CFTR (Cystic Fibrosis Transmembrane Conductance
Regulator) is the most common mutation in CF comprising 70 % of cases
 Dennie Morgan line or fold is an infraorbital fold due to edema, seen in
atopy/allergy.
 Hasners Valve – A fold of mucous membrane at the lower end of the
nasolacrimal duct. It is 1.25cm posterior to the anterior end of inferior
turbinate and 8 to 10 mm below the inferior concha.
 Valve of Rosenmuller – A fold of mucous membrane found at the junction
between the common canaliculus and the lacrimal sac.
 First description of IDL mirror was given by Manual Gracia.
 Sweat Chloride Test –
 In cystic fibrosis, the CFTR chloride channel is defective, and does not allow
chloride to be reabsorbed into sweat duct cells. Consequently, more sodium
stays in the duct, and more chloride remains in the sweat. The concentration of
chloride in sweat is therefore elevated in individuals with cystic fibrosis.
Pilocarpine is injected and sweat is absorbed in a strip placed on skin. The
collected sweat is subjected to test for the amount of chloride. Excess of 70
mmol/L of chloride in a sample weighing in excess of 100 mg is diagnostic of
Cystic Fibrosis.
 FURSTENBERG'S SIGN – Positive in Encephaloceles. Owing to the
intracranial connection, there is pulsation and expansion of the mass with
crying, straining, or compression of the jugular vein (Furstenberg test).
 Autologous graft uses in ENT: Laryngeal injection, Fat myringoplasty,
Fat plug sealing in CSF leaks, Augmentation rhinoplasty.
 Abrahms Cannula – laryngeal cannula for topical anaesthesia. Looks
like Eustachian tube catheter but doesn’t have ring and end has bullous
round point and not flat like ETC.
TRIANGLES IN THYROID SURGERY –
 Joll’s Triangle (sternothyrolaryngeal triangle) – external branch of the
superior laryngeal nerve, which innervates the cricothyroid muscle, usually
runs with the superior pole vessels through Joll’s triangle.
 Boundaries:
 Lateral - Upper pole of thyroid gland and superior thyroid vessels
 Superior - Attachment of the strap muscles and deep investing layer of
Fascia to the hyoid
 Medial - Midline
 Floor - Cricothyroid muscle
 External branch of superior laryngeal nerve lies within this triangle.
 WANGs POINT – Wangs point is 1cm below and caudal to inferior horn of
the thyroid cartilages which can be easily palpated. It is the most constant
position of RLN at Entry into larynx. So wangs point helps us to identify RLN
just before its entry into larynx.
 BEAHR’s TRIANGLE – Medially RLN, Laterally CCA and superiorly is
inferior thyroid artery. The recurrent laryngeal nerve is often encountered
earlier on the right than the left because it is higher (fourth arch derivative)
and is more superficial and lateral.
 TRIANGLE OF CONCERN – The commonest site for bleeding is in the
‘triangle of concern’, comprising the trachea medially and the RLN laterally,
with the thyrothymic ligament and loose fat above the sternum at the base and
Berry’s ligament at the apex. There are many small branches of the inferior
thyroid artery within this triangle that require meticulous hemostasis. A
Valsalva maneuver helps to identify potential bleeding and surgicel™ can be
placed at the apex of the triangle, over the recurrent laryngeal nerve to aid
hemostasis and prevent trauma to the nerve by the suction drain.
 SIMONS TRIANGLE – formed by carotid laterally, inferior thyroid artery
superiorly and esophagus medially. After retracting thyroid lobe medially.
RLN lies in it.
 LORE’s TRIANGLE – trachea medially (like in triangle of concern), carotid
sheath laterally and under surface of retracted inferior thyroid pole superiorly.
Apex towards thoracic inlet.
 ZUCKERKANDL'S TUBERCLE – Zuckerkandl's tubercle is a pyramidal
extension of the thyroid gland, present at the most posterior side of each lobe.
The structure is important
in thyroid surgery as it is
closely related to the
recurrent laryngeal nerve,
the inferior thyroid artery,
Berry's ligament and the
parathyroid glands.
 Poggoban's technique – It’s just a different approach for identifying RLN.
Instead of lateral approach where we search for nerve in the TEG and go