DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Nasal septal deviation.
2. Bilateral inferior turbinate hypertrophy.
3. External nasal valve collapse.
POSTOPERATIVE DIAGNOSES:
1. Nasal septal deviation.
2. Bilateral inferior turbinate hypertrophy.
3. External nasal valve collapse.
OPERATION PERFORMED:
1. External nasal valve reconstruction bilaterally.
2. Septoplasty.
3. Bilateral inferior turbinate coblation with outfracture.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal tube.
ESTIMATED BLOOD LOSS: 30 mL.
OPERATIVE FINDINGS:
1. External nasal valve collapse bilaterally.
2. Right nasal septal deviation with inferior and posterior spurs.
3. Bilateral inferior turbinate hypertrophy causing variable nasal obstruction.
SPECIMENS: None.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male with longstanding nasal obstructive symptoms refractory to medical therapy. Informed consent was obtained after explaining the risks, benefits, and alternatives to the procedures.
DESCRIPTION OF OPERATION: The patient was taken to the operating room. Under general endotracheal tube anesthesia, in the supine position, after appropriate surgical time-outs were called x2, the nose was prepped with Betadine solution and scrubbed and draped sterilely. The nasal septum and both inferior turbinates were injected with 1% lidocaine with 1:100,000 epinephrine. The bilateral intercartilaginous areas were similarly injected.
A right hemitransfixion incision was made sharply and carried down to cartilage. Under direct vision, bilateral mucoperichondrial and mucoperiosteal flaps were elevated to the bony vomer. Taking care to preserve a 1 cm L-strut for good tip support, all deviated anterior quadrangular cartilage and posterior bone was taken down in a through-cutting fashion with open Jansen-Middleton forceps after an approximately 1 x 1 cm window of cartilage was removed to be later used for alar batten grafts. A very significant left inferior spur with disarticulation from the maxillary crest was taken down along its lateral aspect with a V-gouge osteotome. The septum was inspected and palpated and found to be free from further points of obstruction. The hemitransfixion incision was closed with interrupted through-and-through 3-0 chromic sutures. Both inferior turbinates were then coblated at a setting of 6 for 10 seconds each x3 and then outfractured with a Boies elevator.
Next, external nasal valve reconstruction was undertaken. Bilateral intercartilaginous incisions were made sharply. A pocket overlying the piriform aperture was made with Converse scissors. Approximately 1.5 x 0.5 cm alar batten grafts were placed into this pocket. The mucosa was then sutured with 4-0 chromic sutures and a through-and-through 4-0 nylon suture was placed to the graft, woven in place. This was done bilaterally. Bilateral Doyle splints coated in bacitracin were then placed and secured to the septum with 2-0 nylon. The patient’s oronasopharynx were copiously suctioned. The patient was then awoken from anesthesia and extubated and taken to the recovery room in stable and awake condition.
