DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left sinonasal mucormycosis with orbital involvement.
POSTOPERATIVE DIAGNOSIS: Left sinonasal mucormycosis with orbital involvement.
OPERATION PERFORMED: Left orbital exenteration.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Less than 20 mL.
SPECIMENS:
1. Left orbital contents.
2. Orbital floor.
3. Orbital apex.
INDICATION FOR OPERATION: This is a patient with uncontrolled diabetes, who has sinonasal mucormycosis. Despite exenteration of the sinonasal contents in the left, the patient has persistent disease in the orbit, in the left frontal lobe. Decision was made by Neurosurgery and ENT to go back to the operating room for an exenteration of the left orbit. Neurosurgery will perform a left subfrontal craniotomy with drainage of the left frontal lobe abscess. This is the ENT portion of this procedure.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and was placed in the supine position on the operating room table. General facemask anesthesia was given until a deep plane of anesthesia was obtained. At that point, an endotracheal tube was placed by the anesthesiology service without difficulty. The table was then turned, and the patient was placed in head pins by the neurosurgical service. The patient’s face and head were then prepped and draped in sterile fashion. Approximately 4 mL of 1% lidocaine with 1:100,000 epinephrine was injected into the lateral retinotomy and Weber-Ferguson planned incision sites for the orbital exenteration.
After allowing time for decongestion, a 15 blade was used through the lateral retinotomy incision down to the lateral nasal bones. Bipolar cautery was used for hemostasis. Extended Weber-Ferguson incision was then made down to the inferior orbital rim, laterally to the lateral canthus. A superior incision was made through the superior islet down to the superior orbital rim. These incisions were carried down to the bone.
After the orbital rims were dissected free at 360 degree fashion, a Cottle elevator was then used to dissect the orbital contents between the bone and the periorbita. This was carried down deeply until the inferior orbital fissure was identified inferiorly and superiorly. The orbital fissure was identified superiorly. Bipolar cautery was then used to cauterize the root of the optic nerve, the ophthalmic artery, and optic artery. Curved Metzenbaum scissors were then used to cut across the apex of the orbital contents at the superior orbital fissure. The orbit was then removed from the bony orbital vault. Bipolar cautery was then used to further cauterize the orbital apex, secondary cauterization of the orbital apex. Specimen was sent for frozen diagnosis.
The inferior orbit, which was the roof of the maxillary sinus, appeared necrotic in nature. This was removed with Kerrison rongeurs and sent for permanent pathology. Exploration of the sinus contents revealed some mild necrosis of the cribriform plate. This will be explored superiorly through the neurosurgical procedure.
At that point, a wet Ray-Tec was placed in the orbital contents until the neurosurgical part of the procedure was completed. At the end of the procedure, the lateral retinotomy was sewn together with 4-0 Prolene in a horizontal mattress fashion. The orbital socket was then packed with Iodoform gauze. At that point, the patient was extubated and sent to the postanesthesia care unit in stable condition.
