DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Chronic sinusitis with nasal polyps.
POSTOPERATIVE DIAGNOSIS: Chronic sinusitis with nasal polyps.
OPERATION PERFORMED:
1. Left endoscopic partial ethmoidectomy.
2. Right endoscopic total ethmoidectomy.
3. Left endoscopic maxillary antrostomy with removal of tissue from the maxillary sinus.
4. Right endoscopic maxillary antrostomy.
5. Bilateral endoscopic frontal sinusotomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient has a history of chronic sinusitis with nasal polyps not responding to medical therapy.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. General anesthesia was induced through orotracheal intubation. Cotton pledgets with Afrin were placed bilaterally in the nose, and the patient was then draped in the usual fashion. The pledgets were removed, and using the telescope, the left side was examined. Polyps were noted protruding from the middle meatus. The patient notably had a large agger nasi and prominent uncinate process. Xylocaine 1% with 1:100,000 epinephrine was injected over the area of the sphenopalatine ganglion more anteriorly just lateral to the attachment of the uncinate process. On the right side again, the polyps were noted protruding from the middle meatus and a large polyp falling down from the middle meatus toward the posterior choana. Xylocaine 1% with 1:100,000 epinephrine was injected over the area of the sphenopalatine ganglion and then inferior to the attachment of the uncinate process.
The left side was addressed initially. Using a seeker, the uncinate process was medialized and then taken down using the shaver along with the polyps that were attached to the uncinate process. This exposed a maxillary ostium, and there was a small cleft just above this, and looking with an angled telescope and the seeker, this was a cell and not the natural ostium. Therefore, this large opening included the natural ostium. This was extended a little bit posteriorly and then a large polypoid retention cyst within the maxillary sinus was taken down using the curved shaver.
Attention was then directed to the ethmoidal bulla, which really mostly had polypoid disease. This was taken down to fully open the sinus lateralis and expose the basal lamella, which appeared to be relatively normal. Looking up toward the frontal recess, a frontal sinus curette was used to take down the remaining uncinate and then portion of the agger nasi. Polypoid disease was noted filling the frontal recess, which was taken down using the curved shaver.
The area of the frontal sinus was carefully exposed and mucosa was preserved. The scope was used to look medial to the middle turbinate and the superior meatus looked normal, as did the sphenoethmoidal recess. Therefore, the posterior ethmoid was not addressed.
Attention was now directed to the right side. The shaver was used initially to resect polypoid disease to better expose the uncinate process, which was then medialized using a frontal sinus seeker. It was taken down using a backbiter and then the straight and curved Xomed shaver. Again, it was a fairly large opening to the maxillary sinus, which was extended along the posterior fontanelle. The maxillary sinus otherwise looked clear, and looking with an angled scope, this appeared to incorporate the natural ostium. Here, the ethmoidal bulla was fairly large and was taken down using the shaver. This exposed the basal lamella, which was somewhat polypoid, and therefore, the posterior ethmoid was entered.
The basal lamella was taken down and the resection proceeded back to the rostrum of the sphenoid; although, a skeletonized dissection was not performed in the posterior ethmoid. Looking medial to the middle turbinate, the superior meatus looked fine, and although there was some edema within the sphenoethmoidal recess, the ostium was visualized. Then, using an angled telescope, the frontal recess was addressed. Using a frontal sinus curette, portions of the agger nasi were taken down. Giraffe forceps was used to remove further bone in the frontal recess to better expose the frontal nasal opening.
At this point, Sepragel was placed into the frontal recess and frontal sinus on each side, after which a rolled piece of MeroGel was placed into the right middle meatus after first soaking in saline. On the left, Surgiflo was placed into the middle meatus. The patient tolerated the procedure well without complications. General anesthesia was then reversed. The patient was extubated in the operating room and brought to the recovery room in stable condition.
