DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Chronic sialorrhea with frequent pneumonia.
POSTOPERATIVE DIAGNOSIS: Chronic sialorrhea with frequent pneumonia.
OPERATIONS PERFORMED:
1. Bilateral submandibular gland resection.
2. Bilateral Stensen’s duct ligation.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia through the tracheostomy tube.
ESTIMATED BLOOD LOSS: Less than 50 mL.
SPECIMENS: Bilateral submandibular glands.
DESCRIPTION OF OPERATION: After consent was obtained from the patient, the patient was taken to the operating room. He was placed in the supine position. General anesthesia was given. Once a deep plane of anesthesia was obtained, the patient was prepped and draped in sterile fashion. The surgery began with the left submandibular gland resection.
A horizontal incision was made two fingerbreadths below the mandible. The incision was approximately 4 cm in length. The incision was carried down through deep to the platysma muscle. The inferior border of the submandibular gland was identified. Dissection was carried along the capsule of the submandibular gland. The facial vein was identified, cross-clamped, cut, and tied. The facial artery was dissected free from the submandibular gland and preserved.
The dissection was carried superiorly and anteriorly to Wharton’s duct. The lingual nerve was identified and preserved. The submandibular gland was clamped, cross cut, and tied with 3-0 silk suture. Wharton’s duct was carried up to the floor of the mouth and cross-clamped with a 90-degree clamp and cut. This was tied with 3-0 silk tie.
The submandibular gland was then removed and sent for permanent pathology. The twelfth cranial nerve was identified and was preserved in its entire extent. The wound was sterilely irrigated. Hemostasis was obtained with bipolar Bovie cautery. A #7 JP drain was placed and sewn with a 2-0 Prolene. The wound was closed in layered fashion with 3-0 Vicryl to reapproximate the platysma and 5-0 Monocryl to reapproximate the skin.
Attention was then turned toward the right submandibular gland. Again, a horizontal incision was made two fingerbreadths below the mandible; this was 4 cm in length. This was made with a 15 blade down through the platysma muscle.
At that point, Bovie cautery was used to identify the inferior border of the submandibular gland. The facial vein was identified, cross-clamped, cut, and tied with 3-0 silk suture. This allowed preservation of the marginal mandibular nerve. This nerve was also identified and preserved on the contralateral side. Dissection was carried along the plane of the submandibular gland anteriorly and superiorly. The facial artery was identified and dissected free from the submandibular gland. The omohyoid muscle was identified and an Army-Navy retractor was placed to identify the lingual nerve, which was preserved.
The submandibular gland was cross-clamped, cut, and tied with 3-0 silk suture. This allowed identification of the Wharton’s duct. This was dissected free, cross-clamped, cut, and tied with 3-0 silk suture. The submandibular gland was then removed and sent for permanent pathology. The wound was sterilely irrigated with normal saline. Hemostasis was obtained with bipolar cautery. The twelfth cranial nerve was preserved. The wound was then closed in layered fashion after placement of a #7 JP drain. The JP drain was sewn at the neck with 2-0 Prolene suture. The platysma was reapproximated with 3-0 Vicryl. The skin was reapproximated with 5-0 Monocryl.
Attention was then turned towards Stensen’s ducts bilaterally. A lacrimal probe was placed in the Stensen’s duct on the right. An incision was made anterior and posterior to Stensen’s duct. A horizontal mattress suture was then placed around the duct and tied for ligation of the duct. The mucosal incisions were then reapproximated with 3-0 chromic sutures. Attention was then turned to the left Stensen’s duct. The lacrimal probe was placed into the duct. Incision was made anterior and posterior to the probe. A 3-0 Vicryl stitch was placed in a horizontal mattress fashion to tie off the duct on the left. The mucosa was reapproximated with 3-0 Vicryl stitches. This completed the case. The patient was then awoken from general anesthesia and sent to the postanesthesia care unit in stable condition.
