DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right submandibular gland sialolithiasis.
POSTOPERATIVE DIAGNOSIS: Right submandibular gland sialolithiasis.
OPERATION PERFORMED: Right submandibular gland excision.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 50 mL.
SPECIMENS: Right submandibular gland.
DESCRIPTION OF OPERATION: The patient was brought 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 turned, and the patient was prepped and draped in a sterile fashion.
A 4 cm horizontal incision was made in a skin crease approximately three fingerbreadths below the right mandible. This was injected with 8 mL of 1% lidocaine with 1:100,000 epinephrine mixed 1:1 with 0.25% bupivacaine. After allowing time for decongestion, an incision was made with a 15 blade through the superficial skin into the subcutaneous fat. Bovie cautery was then used to dissect through the platysma muscle. Pickups with mosquito dissection and Bovie cautery was used to identify the inferior border of the submandibular gland. The overlying tissues were dissected free from the submandibular gland to protect the marginal branch of the facial nerve. The facial vein was identified, cross-clamped, cut and suture ligated with 3-0 silk suture.
Dissection was then carried inferiorly to the floor. The mylohyoid muscle was then identified in its superior to inferior extent. The lateral border of the submandibular gland was then freed from the surrounding tissue with mosquito snap and Bovie cautery. After the submandibular gland was liberated from the surrounding tissue in the lateral superior and inferior extents, an Army-Navy was placed under the mylohyoid muscle. The lingual nerve was identified and attachment to the submandibular gland was transected. The lingual nerve was intact through its entire extent. The submandibular duct was identified and followed superiorly through to the floor of the mouth. At that point, it was cross-clamp cut and sutured with 3-0 silk suture.
At that point, the final attachments of the gland to the surrounding tissue was dissected free with a mosquito dissector. The wound was then thoroughly irrigated. Hemostasis was obtained with bipolar cautery. The wound again was thoroughly irrigated, and there was no evidence of further bleeding. At that point, a quarter-inch Penrose drain was placed into the wound through a separate stab incision. The wound was then closed in layered fashion with 3-0 Vicryl deeply and 5-0 Monocryl to reapproximate the skin edges. Mastisol and Steri-Strips were placed. A pressure dressing was then placed over the wound closure. Surgery was then terminated. The patient was awoken from general anesthesia, extubated, and sent to the postanesthesia care unit in stable condition.
