Browsing by Author "Jonas, Nico"
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- ItemOpen AccessAdenoidectomy Surgery Technique(University of Cape Town, 2025-03-08) Jonas, Nico; Fagan, JohanAdenoidectomy may be done in isolation or combined with tonsillectomy. Adenoidectomy may be either total or partial. Partial adenoidectomy involves leaving a ridge of adenoidal tissue inferiorly in the area of Passavant's ridge to enable apposition of the soft palate to the posterior pharyngeal wall during swallowing; it is indicated when there is concern about causing velopharyngeal insufficiency (VPI) e.g. with a submucous cleft palate. Indications: Adenoidectomy is frequently combined with tonsillectomy and/or insertion of grommets. Other indications include: •Obstructive sleep apnoea •Nasal obstruction •Problematic rhinorrhoea •Recurrent upper respiratory tract infec-tion •Recurrent acute otitis media •Recurrent otitis media with effusion •For histological analysis
- ItemOpen AccessChoanal Atresia Surgery(2025-04-22) Tan, Neil; Jonas, NicoChoanal atresia is defined as a blockage of the posterior nasal openings. It is a rare condition and has an incidence of 1/7000 live births. It can be unilateral or bilateral. The blockage is purely bony in 30% of cases; in the remaining 70% it is a mixed bony and membranous obstruction (Figure 1). Complete total bony obstruction is extremely rare. It is believed that membranous obstruction occurs due to failure of the bucconasal membrane to rupture sometime between the 5th and 6th weeks of foetal development. Bony obstruction occurs due to a combination of: •A narrow nasal cavity •Medial thickening of the medial ptery-goid plate •Lateral thickening of the vomer
- ItemOpen AccessFrenulotomÃa & FrenulectomÃa para Anquiloglosia (Frenillo Lingual)(University of Cape Town, 2017) Diale, Ndivhuwo; Peer, Shazia; McGuire, Jessica; Fagan , Johan; Jonas, NicoEste capÃtulo describe la frenulotomÃa y la frenulectomÃa como procedimientos quirúrgicos para el tratamiento de la anquiloglosia (frenillo lingual corto). Se revisan la anatomÃa del frenillo lingual, los sistemas de clasificación de la anquiloglosia, las indicaciones para la intervención y las técnicas quirúrgicas utilizadas en pacientes pediátricos. También se abordan los cuidados perioperatorios, las posibles complicaciones y las opciones de revisión quirúrgica, incluida la frenuloplastia en Z. Este recurso está dirigido a profesionales sanitarios involucrados en el diagnóstico y tratamiento de trastornos funcionales relacionados con la movilidad lingual.
- ItemOpen AccessPaediatric Bronchoscopy for Foreign Bodies(University of Cape Town, 2025-03-08) Jonas, Nico; Fagan, JohanThis chapter only addresses management of foreign bodies in the airway from the laryngeal inlet down to and including the bronchi. Due to the cone shape of the paediatric cricoid cartilage, the subglottis is the narrowest part of the trachea in the paediatric patient (Figure 1). If an aspirated foreign body is small enough to pass beyond the subglottic area then the most likely site of impaction is in the main bronchi. The right main bronchus is more vertically aligned and therefore the most common location of a distally lodged foreign body. The decision whether a bronchoscopy is required is based on history, clinical examination and chest x-ray findings. If there is strong suspicion of a foreign body based on history, clinical findings and/or x-ray, then bronchoscopy should be performed. It is acceptable to have negative bronchoscopy findings, but unacceptable to miss a foreign body because bronchoscopy was omitted. X-ray findings can be conclusive in cases of radio-opaque foreign bodies, or subtle when dealing with radiolucent ones. In the latter case, findings may include hy-perinflation during air trapping, segmental consolidation or collapse (Figure 2).
- ItemOpen AccessPaediatric Tonsillectomy(University of Cape Town, 2025-11-10) Grainger, Joe; Jonas, Nico; Fagan, JohanTonsil surgery includes tonsillectomy where the aim is complete removal of the tonsil, compared to tonsillotomy where the aim is to remove part of the tonsil in order to create more space in the oropharynx. Indications for tonsillotomy are limited and include surgery for sleep disordered breathing in very young children where the aim is to limit morbidity associated with postoperative pain and bleeding. Intracapsular tonsillectomy (IT) is now the preferred technique for many paediatric ENT surgeons. The aim of this procedure is to remove all tonsil tissue while preserving the deep part of the tonsil capsule and to avoid injury to the palatopharyngeus, palatoglossus and pharyngeal constrictor muscles.
- ItemOpen AccessPaediatric Tracheostomy(University of Cape Town, 2025-03-08) Ismail-Koch, Hasnaa; Jonas, Nico; Fagan, JohanTracheotomy refers to making an opening into the trachea whilst tracheostomy refers to creating a formal stoma and a communication between the trachea and the overlying skin. The open tracheostomy technique in paediatric patients differs from that done in adults. In paediatric patients a formal stoma is created by suturing the tracheal wall to the skin with maturation sutures in addition to safety stay sutures placed in the tracheal wall. Indications: •Upper airway obstruction due to con-genital or acquired causes •Patients requiring long-term ventilation •Failure to wean from conventional orotracheal or nasotracheal ventilation (eliminates dead space) •Pulmonary toilet
- ItemOpen AccessSupraglottoplasty for Laryngomalacia(University of Cape Town, 2025-04-18) Jonas, Nico; van der Meer, Graeme; Fagan, JohanLaryngomalacia is characterised by collapse of the supraglottic tissues on inspiration. It is the most common cause of stridor in infancy. It generally becomes symptomatic 2-3 weeks after birth, and presents as characteristic high-pitched, inspiratory, squeaking stridor. Classically symptoms are worse in the supine position, when the child cries, or is agitated. Males are affected twice as often as females. It usually resolves by the age of 2 years. Laryngomalacia may remain symptomatic beyond 2 years in patients with neuromascular disorders and should be considered in the differential diagnosis of inspiratory stridor even in older children. The aetiology is not fully understood. There does appear to be a familial predisposition. Anatomically, redundant supraglottic soft tissues collapse on inspiration and cause supraglottic airway obstruction. Another theory is that of immature neuromuscular development causing supraglottic compromise. A common coexisting condition is that of acid reflux which may exacerbate laryngomalacia by causing posterior supraglottic oedema.
- ItemOpen AccessTreatement of Epistaxis in Children(University of Cape Town, 2025-05-18) Hadijisymeou, Simone; Jonas, Nico; Fagan, JohanEpistaxis (bleeding from the nose) occurs commonly in children. They usually seek medical attention when it becomes a recurrent problem. It can be classified by its anatomic location into anterior and posterior epistaxis; anterior epistaxis is far more common. The nose has a rich vascular supply withsubstantial contributions from arteries originating from both the internal (ICA) and the external (ECA) carotid arteries. The ECA system supplies blood to the nosevia the facial and internal maxillary arteries. The superior labial artery is a terminalbranch of the facial artery and contributesto the blood supply of the anteriornasal floor and anterior septum through itsseptal branch. The internal maxillary arteryenters the pterygopalatine fossa where itdivides into 6 branches: posterior superior alveolar, descending palatine, infraorbital, sphenopalatine, pterygoid canal, and pharyngeal (Figures 1 & 2). The descending palatine artery descends through the greaterpalatine canal and supplies the lateral nasal wall; a branch then returns to the nasalcavity via the incisive foramen to supplythe anterior nasal septum. The sphenopalatine artery enters the nose near the posterior attachment of the middle turbinate to supply the lateral nasal wall; a branch also supplies the nasal septum.