DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Nasal fracture.
2. Nasal airway obstruction.
POSTOPERATIVE DIAGNOSES:
1. Nasal fracture.
2. Nasal airway obstruction.
OPERATION PERFORMED:
1. Closed reduction, nasal fracture.
2. Nasal airway reconstruction.
ANESTHESIA: General endotracheal.
BLOOD LOSS: 20 mL.
COMPLICATIONS: None.
OPERATIVE FINDINGS: Nasal dorsal deviation to the left severely with convex left nasal bone, concave right nasal bone, and convoluted nasal septum obstructing both left and right nasal airways with hypertrophic turbinates.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. After successful general endotracheal anesthesia was established, an oropharyngeal pack was placed. Cocaine and 1% Xylocaine with 1:100,000 epinephrine was placed bilaterally intranasally. The patient was draped.
We began by injecting 3 mL of saline to the hypertrophic left inferior turbinate and then delivered 300 joules of radiofrequency energy posteriorly and 300 joules anteriorly. On the contralateral side of the nose, we injected 3 mL of saline to the hypertrophic inferior turbinate and placed 300 joules of radiofrequency energy posteriorly and 300 joules anteriorly. We then made a standard left Killian incision in the mucoperichondrium. Mucoperiosteal flaps were elevated. The quadrangular cartilage was disarticulated from the bony septum posteriorly, and the obstructing portion of bony septum was conservatively resected. A thin strip of inferior quadrangular cartilage was resected conservatively. Superior relaxing incisions were made. Both inferior turbinates were laterally outfractured. These maneuvers greatly improved the patient’s airway. Plain suture around a Keith needle was used circumferentially to reapproximate the mucoperichondrial flaps. Two of these sutures were placed.
The Killian incision was closed with 4-0 chromic in a running fashion. We then, with digital manipulation, infractured the left nasal bone, outfractured the right nasal bone, serving to bring the nasal dorsum to a more normal midline position. Denver splint was placed externally. A mustache dressing was placed externally. Telfa and bacitracin were internally placed. The oropharyngeal pack was removed. Blood loss was estimated at 20 mL. There were no surgical complications.
