DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Deviated nasal septum.
2. Bilateral inferior turbinate hypertrophy.
POSTOPERATIVE DIAGNOSES:
1. Deviated nasal septum.
2. Bilateral inferior turbinate hypertrophy.
OPERATION PERFORMED:
1. Septoplasty.
2. Bilateral inferior turbinate reduction.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 150 mL.
SPECIMENS: None.
CONDITION: Stable.
DESCRIPTION OF OPERATION: The patient came to the operating room and was placed in the supine position on the operating table. An endotracheal tube was placed by the anesthesiology service without difficulty. At that point, approximately 8 mL of 1% lidocaine with 1:100,000 epinephrine was injected into the septum bilaterally, into the bilateral inferior turbinates. Afrin-soaked pledgets were then placed in the nasal cavities. After allowing time for decongestion, the nasal pledgets were removed.
The surgery began with the right inferior turbinate. A 15 blade was used to make a nick incision over the inferior turbinate bone anteriorly. A turbinate reduction Straight Shot microdebrider was then used to submucosally remove the bulk of the inferior turbinate tissue with preservation of the overlying mucosa. After completion of the reduction, the turbinate bone was infractured and then outfractured for more reduction and increase of the nasal airway.
The left inferior turbinate was then addressed. Again, a 15 blade was used to make a nick incision in the anterior head of the inferior turbinate down to the bone. A caudal elevator was used to elevate the submucosal tissue off of the underlying bone. A Straight Shot microdebrider was then used to reduce the tissues under the mucosa. A small rent in the mucosa was made. After completion of the reduction with the microdebrider, the bone was infractured and outfractured.
Attention was then turned towards the septoplasty. On the right side, a vertical incision was made in the caudal septum from the roof to the floor. A submucosal plane was then elevated posteriorly over the septal cartilage and bone. The cartilage was then transected approximately 1 cm behind the caudal margin of the septum and at least 1 cm from the roof of the septum. The contralateral mucosa was elevated. There was a severe linear asymmetry of the cartilaginous septum. The midpoint was parallel to the floor of the nasal cavity. This required very delicate dissection. A linear tear was made in the right mucosal flap. The left mucosal flap was completely intact. A Jansen-Middleton was then used to remove a large window of septal cartilage back to the bone. The bone was in the midline and did not have to be removed. After removal of the septal cartilage, both nares were visually evaluated, and there was a very good airway with the midline septum.
The mucosal layers were sewn back together in a mattress fashion with a 3-0 plain gut suture. The hemitransfixion incision was sewn back together with a 3-0 chromic suture. Doyle splints soaked in bacitracin ointment were then placed into the nasal cavities bilaterally. These were sewn in place with a 3-0 Prolene suture. The nasopharynx and cavities were thoroughly irrigated and then suctioned. There was no evidence of acute bleeding at the end of the case. At that point, the procedure was terminated. The patient was then awoken from general anesthesia, extubated and sent to the postanesthesia care unit in stable condition.
