DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Recurrent epistaxis with hereditary hemorrhagic telangiectasia.
POSTOPERATIVE DIAGNOSIS: Recurrent epistaxis with hereditary hemorrhagic telangiectasia.
OPERATION PERFORMED:
1. Endoscopic cautery destruction of intranasal telangiectasias using the KTP laser.
2. Control of nasal hemorrhage with placement of septal splints.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient has a history of chronic recurrent epistaxis bilaterally with a history of hereditary hemorrhagic telangiectasia. The patient had failed topical humidification and therefore was taken to the operating room for more definitive intervention.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. General anesthesia was induced with orotracheal intubation. Cotton pledgets soaked with Afrin were placed bilaterally in the nose, and the patient was draped in the usual fashion with precautions taken for use of the KTP laser. The pledgets were removed, and already, there was some bleeding noted bilaterally. On the right, it was mostly from the anterior septum and floor and anterior inferior turbinate. These areas were addressed using the KTP laser set at 2 watts, but in addition, the suction Bovie cautery was used for some of the more significant areas that were bleeding, particularly along this septal floor. The pledget with Afrin was placed, and a similar procedure was done on the opposite side. Most of the telangiectasias were on the anterior septum, both superiorly and inferiorly. They did extend back to the mid septum. Several telangiectasias on the inferior turbinates were also addressed. After cautery, using the KTP laser, the nasal cavity was aggressively irrigated with warm saline. The Doyle splints were then applied and secured with Bactroban ointment and 4-0 Prolene stitch. We would add that a small piece of Surgicel was placed on the right anterior inferior septum at a site that was particularly bleeding, but no bleeding was noted at the conclusion of the procedure. We would also add that 1% Xylocaine with 1:100,000 epinephrine was injected along the anterior septum bilaterally and small amount was placed on the anterior inferior turbinate to help control bleeding. The patient tolerated the procedure well without complications. General anesthesia was then reversed, and the patient was brought to recovery in stable condition.
