DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Mandibular fracture, bilateral subcondylar fracture.
POSTOPERATIVE DIAGNOSIS: Mandibular fracture, bilateral subcondylar fracture.
OPERATIONS PERFORMED:
1. ORIF of mandibular fracture.
2. Application of maxillomandibular fixation.
SURGEON: John Doe, MD
ANESTHESIA: General and 10 mL of a 1:1 mix of 1% lidocaine with epinephrine and 0.5% Marcaine plain.
ESTIMATED BLOOD LOSS: Minimal.
DESCRIPTION OF OPERATION: After explaining potential risks and benefits of the procedure to the patient, written consent was obtained. The patient was taken to the operating room by gurney and transferred to the operating room table in the supine position. An endotracheal tube was placed and secured into position with an 0 silk suture through his septum. The patient’s mouth was prepped with Peridex and the above local anesthetic was infused superiorly and inferiorly into the gingival buccal sulcus. A timeout was performed indicating the patient, the procedure, and site to be operated on. One gram of Ancef was given preoperatively.
First, we placed arch bars on both the upper and lower dentition. The patient had very damaged and poor dentition, and therefore, it was somewhat difficult to get adequate fixation. However, this was performed on the superior and inferior rows of teeth. Once fixation had been applied, we then made a gingival buccal sulcus incision and dissected down to the level of the mandible, stripped the mandible of mentalis and overlying muscle. The mental foramina were visualized bilaterally. The nerves were intact.
Once we visualized the fracture, we then debrided the fracture off any granulation tissue. The fracture was then reduced with a reduction clamp and two 2.0 Mini Plates were applied, one along the inferior border with bicortical screws and one along the superior border with unicortical screws. The reduction clamp was replaced and the mandible stayed in good reduction. The mandible subcondylar fractures were addressed by application of MMF. The arch bars had already been placed. The patient was pulled up into proper occlusion and his mouth wired shut. Prior to wiring mouth shut, a previously placed throat pack was removed and an NG tube was placed and put on suction to clean his stomach and oropharynx out.
The incision was then irrigated and closed with 3-0 chromic suture with 3-0 Vicryl suture suspending the mentalis. The patient tolerated the procedure well without any immediate complications. He was awoken from anesthesia and taken to the recovery room. The patient left the operating room in good condition.
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Dental infection with a behavior problem.
POSTOPERATIVE DIAGNOSIS: Dental infection with a behavior problem.
DESCRIPTION OF PROCEDURE: This (XX)-year-old girl was brought into the operating room and placed in the supine position. After a satisfactory level of general anesthesia had been administered by nasotracheal intubation, a 4 x 4 gauze throat pack was placed and the following dental procedures were then carried out based upon a thorough oral examination and radiographs, which are available to review.
The upper right second primary molar and both lower second primary molars were excavated of caries and prepared to receive stainless steel crowns. Prior to crown placement, a pulpotomy was performed on these three teeth. Crowns were closely fitted to these teeth and cemented with FujiCEM cement. The upper left primary canine and first and second primary molars were excavated of caries and restored with light-bonded Z100. The lower right first primary molar was then extracted by means of elevator and forceps. Tissue around the extraction site was closely approximately and sutured with 3-0 chromic suture.
A thorough prophylaxis with topical fluoride was then performed. The mouth was suctioned, throat pack removed, and the patient was taken to the recovery room in satisfactory condition having tolerated the procedure well.
