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Derrick Scott
5 years ago
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1 Log Book Summary Name: This reporting period from to Cumulative duration of higher training: (months) Revised 24 March 2004 A. Operations Performed Procedures of high level of skill Otology cumulative Cumulative Canaloplasty for aural atresia, stenosis Cerebello-pontine angle tumour/mass removal Cochlear implant, brain stem implant Decompression of endolymphatic sac Facial nerve exploration, decompression, repair *Mastoidectomy (> =10) Ossiculoplasty Otoplasty for microtia, severe deformity Repair of round window or oval window fistula Stapedectomy Vestibular neurectomy Tumor of external or middle ear resection Rhinology Choanal atresia operation Dacryo-cysto-rhinostomy endoscopic, external *FESS endoscopic ethmoidectomy, frontoethmoidectomy, sphenoidectomy (>=30) External fronto-ethmoidectomy, obliteration Maxillary, sphenopalatine or ethmoid artery ligation Orbital, optic nerve decompression, biopsy Repair CSF leak Rhinoplasty *Sleep related breathing disorder hyoid suspension, maxilla/mandible/tongue advancement ( >= 10 counted together with other inediate procedures) Laryngology Laryngeal fractures and dislocations - open reduction Laryngeal/tracheal stenosis, laryngomalacia, web, cleft endolaryngeal/open operation, stenting, reconstruction Laryngeal diversion Pharyngeal diverticulum operation 1

2 Endolaser surgery benigh tumor papillomatosis, haemangioma Submandibular duct relocation Surgical treatment of tracheostomy complications - fistula Vocal cord palsy procedures - thyroplasty, arytenoid adduction/abduction, cord repositioning Laryngeal framework procedure for indications other than cord palsy Head and Neck Surgery Craniofacial malformation, cleft lip reconstruction Exploration for major complications haemorrhage, CSF leakage, chyle leakage, sepsis, flap failure, fistula Facial reanimation - nerve graft, muscle transplant, sling, face lift, blepharoplasty Fistula repair branchial, pharyngeal, tracheal Flap revascularized free Flap regional pedicle Fracture maxilla, orbit, zygoma, mandible - reduction, fixation Manubrium resection Neck dissection Parotidectomy Parathyroidectomy Removal of foreign body in trachea and bronchus Resection of tumor of hypopharynx and esophagus Resection of tumor of larynx partial or Resection of tumor of lateral skull base Resection of nasopharyngeal tumor Resection of tumor of nose, sinus, anterior skull base Resection of tumor of oral cavity, mandible Resection of tumor of oropharynx Resection of tumor of parapharyngeal space carotid body/glomus tumor, paranasopharyngeal tumor, brachial cyst, any other large size tumor/mass Resection of tumor of skin/scalp with flap reconstruction Resection of tumor of trachea Submandibular gland excision Thyroidectomy Vascular graft Sub of all High Level Procedures 2

3 Procedures of Inediate Level of Skill Otology Aural exostosis - simple removal cumulative Cumulative Bone anchored hearing aid Meatoplasty *Myringoplasty (>=40) Otoplasty of simple auricular deformity, bat ear Rhinology Antrostomy inferior, middle meatus Caldwell-luc operation *Deviated nasal septum - septoplasty, submucosal resection (>= 20) Oro-antral fistula, closure *Sleep related breathing disorder - LAUP, UPPP, tongue base suspension/resection, radiofrequency ablation (>=10 counted together with other high skill procedures) Laryngology Arytenoid subluxation laryngoscopic reduction Botox injection for spasmodic dysphonia *Microlaryngoscopic surgery - nodule, polyp, Reinke s edema (>= 20) Pharyngoplasty *Tracheostomy temporary, permanent, revision (>=20) *Tonsillectomy (>=30) Vallecular cyst, removal Vocal cord palsy procedures cordectomy, arytenoidectomy, injection medialization Head and Neck Surgery Abscess in submandibular, parapharyngeal, thyroid drainage Botox injection Cleft palate - local flap repair Facial reanimation - gold weight Flap -local Gold grain implant of nasopharyngeal tumor Removal of foreign body in esophagus Removal of salivary duct stone, +/- endoscope Ligation of carotid artery 3

4 Mass excision thyroglossal cyst, small/simple tumor/mass, lipoma, neurofibroma, nasolabial cyst Osteointegrated implant Ranula - marsupialization or excision of sublingual gland Resection of tumor of skin and scalp primary closure Scar revision Skin graft Stricture of pharynx, esophagus - dilatation Tracheoesophageal puncture for voice rehabilitation or repair/closure / excision of TE fistula Sub of all Inediate Procedures Procedures of Minor Level of Skill Otology cumulative Cumulative Haematoma auris drainage, buttoning, excision Myringotomy alone Myringotomy + insertion of grommet Other (specify): Rhinology Adenoidectomy Nasal polyp, simple polypectomy Removal of foreign body in nose Turbinectomy/turbinoplasty, laser/thermal/radiofrequency ablation of turbinate Other (specify): Laryngology Removal foreign body in pharynx, larynx Other (specify): Head and Neck Surgery Superficial abscess of head & neck incision Fracture nasal bone - simple closed reduction Oral lesion, retention cyst, torus palatinus, dental cyst - simple excision/ biopsy Preauricular cyst or sinus excision Peritonsillar abscess incision Skin or subcutaneous benigh mass excision, biopsy Lymph node biopsy Repair superficial cutaneous wound Other (specify) Sub of all Minor Procedures 4

5 B. Endoscopic or Microscopic Examination Procedures +/- Biopsy: flexible or rigid endoscopy, microscopy examination procedures+/- biopsy, Nasoendoscopy/nasopharyngoscopy - flexible, rigid, +/- biopsy Sinuscopy, antral wash out, +/- biopsy Laryngoscopy - flexible, +/- biopsy Laryngoscopy +/- micro/endoscopic - rigid, +/- biopsy Stroboscopy, +/- biopsy Bronchoscopy - flexible, +/- biopsy Bronchoscopy - rigid, +/- biopsy Esophagoscopy - flexible, +/- biopsy Esophagoscopy - rigid, +/- biopsy Paediatric flexible laryngoscopy, +/- biopsy Paediatric rigid laryngoscopy, +/- biopsy Paediatric flexible bronchoscopy, +/- biopsy Paediatric rigid bronchoscopy, +/- biopsy Paediatric esophagosopy - flexible, +/- biopsy Paediatric esophagoscopy - rigid, +/- biopsy Biopsy of ear lesion under microscopy Endoscopic examination of salivary duct in this cumulative ( only need to report up to 30 for each procedure) C. Other Non-operative Non-endoscopic Procedures: in this period BPPV - canalith repositioning Skin allergy test Ear wax removal Change voice prosthesis Pure tone audiometry Tympanometry cumulative (only need to report up to 10 for each procedure) D. Temporal Bone Dissection Procedures: Cortical mastoidectomy Facial recess dissection Extended facial recess dissection Intact canal wall and decompressing tympanic and vertical portion of VII Exposure of the endolymphatic sac Tympanic ring removal Labyrinthectomy Translab. Opening of the IAM Number of procedures performed this 5

6 Middle fossa approach to IAM Total VII decompression (intact canal and middle fossa) Canal wall down mastoidectomy Stapedectomy Ossiculoplasty Other Procedures: E. Cadaveric FESS Dissection Procedures: Complete fronto-sphenoethmoidectomy Endoscopic DCR Endoscopic orbital decompression Endoscopic optic nerve decompression Endoscopic pituitary surgery Endoscopic repair skull base defect Endoscopic nasopharyngectomy Other procedures: Number of procedures performed this F. Training Course: Temporal bone dissection course: FESS Course: Others: G. Journal Review and Presentation: 6

7 H. Congress / Conference Attendance and Presentation: I. Publication: 7

Surgical Privileges Form: ORL - HNS

Surgical Privileges Form: ORL - HNS Surgical Form: ORL - HNS Clinical Request Applicant s Name:. License No. (If Any):... Date:... Scope of Practice:. Facility:.. Place of Work:. CATEGORY I: GENERAL PRIVILEGES 1. Admitting privileges 2.