POSTOPERATIVE DIAGNOSIS: Hard palate neoplasm.

PROCEDURES PERFORMED:
1. Wide local excision hard palate neoplasm.
2. Reconstruction with combination of buccal free graft and myomucosal advancement flap.

ATTENDING SURGEON: John Doe, MD

ANESTHESIA: General endotracheal tube.

ESTIMATED BLOOD LOSS: 20 mL.

FINDINGS: A 0.9 cm neoplasm of hard palate with a 1.5 cm defect following excision.

SPECIMENS: Hard palate neoplasm, sent to Pathology.

COMPLICATIONS: None.

DISPOSITION: To recovery room, stable.

INDICATIONS FOR OPERATION: A (XX)-year-old male with slowly growing hard palate neoplasm suspicious for neoplasm on clinical examination. Informed consent explaining the risks, benefits, and alternatives of the procedure was obtained from the patient.

OPERATION IN DETAIL: In the operating room under general endotracheal tube anesthesia, in the supine position, after appropriate surgical time-outs were called x2, the hard palate was injected with 0.25% Marcaine with 1:100,000 epinephrine. A McIvor gag retractor was inserted intraorally and used to reflect the tongue downwards. The hard palate neoplasm was outlined with the Colorado tip of the Bovie cautery with 3 mm margin surrounding circumferentially.

The needle tip of the electrocautery was then used to excise the hard palate neoplasm down to periosteum. Periosteum elevation was undertaken, and the neoplasm sent off to Pathology as a specimen. Incisions were made bilaterally in the soft palate and this was extensively undermined. The soft palate advancement flap was then advanced to partially close the full-thickness defect. This was sutured in place with 3 and 4-0 Vicryl.

There was a residual defect measuring approximately 1 x 1 cm. A 1 x 1 cm full-thickness buccal mucosa free graft was then taken from the right buccal mucosa taking care to spare injury to Stensen duct. This area was closed with interrupted 3-0 Vicryl deeply and mucosally. The buccal graft was then used to fill the remaining hole in the hard palate and the buccal graft was sutured in place with interrupted 4-0 Vicryl. Tisseel fibrin sealant was then used to secure the graft further. Hemostasis was found to be excellent.

The wound was copiously irrigated, made meticulously hemostatic with bipolar cautery, and hemostasis found to be excellent. Of note, prior to the incision, the mouth was sterilized with dilute Betadine solution, and the patient was given intravenous clindamycin.

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DATE OF OPERATION: MM/DD/YYYY

PREOPERATIVE DIAGNOSIS: Deep lobe parotid tumor.

POSTOPERATIVE DIAGNOSIS: Deep lobe parotid tumor.

OPERATION PERFORMED: Total parotidectomy and facial nerve dissection.

SURGEON: John Doe, MD

ASSISTANT: Jane Doe

OPERATIVE FINDINGS:
1.  A 3 cm deep lobe tumor.
2.  Facial nerve identified and preserved in all branches.

SPECIMENS: Superior and deep parotid lobes sent to pathology.

ESTIMATED BLOOD LOSS: 30 mL.

INDICATION FOR OPERATION: The patient is a (XX)-year-old male with slowly-growing right parotid tumor, concerning for possible mucoepidermoid carcinoma on fine needle aspiration. Informed consent explaining the risks, benefits, and alternatives of the procedure was obtained from the patient for total parotidectomy and facial nerve dissection.

DESCRIPTION OF OPERATION: The patient was brought to the operating room. Under general endotracheal tube anesthesia, in the supine position, after appropriate surgical time-outs were called x2, the patient was connected to the nerve integrity monitor for continuous facial nerve monitoring throughout the case. A preauricular sulcus skin incision was marked with a marking pen and extended down below the right ear lobule and into the right neck in a curvilinear fashion. This was injected with dilute epinephrine solution. The neck and face were prepped with Betadine solution and scrubbed and draped sterilely.

A skin incision was made sharply and carried down through subcutaneous tissues with Bovie electrocautery. Skin flaps were elevated anteriorly with Bovie electrocautery and then bluntly at the anterior-most aspect, just past the tumor. The anterior border of the sternocleidomastoid muscle was skeletonized with Bovie electrocautery and blunt dissection until the posterior belly of the digastric muscle was identified. This was dissected superiorly. The tragal pointer was then skeletonized. Using the tragal pointer and posterior belly of the digastric muscle as landmarks, all tissue overlying the main trunk of the facial nerve was carefully dissected under loupe magnification in a blunt fashion and made hemostatic with bipolar cautery until the main trunk of the facial nerve was identified. This was identified quite deep.

Then, using a right angle hemostat and meticulous dissection technique using loupe magnification, each branch including the temporozygomatic branch and the marginal mandibular branch of the facial nerve were dissected and parotid tissue overlying this was divided with the Harmonic scalpel. The buccal branches were similarly dissected out. The tumor was found to be deep to the facial nerve and approximately 3 x 3 cm in size. After each of the branches of the facial nerve was dissected, as mentioned above, the superficial lobe of the parotid gland was sent off the table to pathology as a specimen.

Of note, during the dissection, the marginal mandibular branch of the facial nerve was carefully identified and dissected in its entirety as was the temporozygomatic branch and the buccal branches. Also noted during the dissection, the great auricular nerve was identified and dissected free and preserved.

Next, the branches of the facial nerve overlying the deep lobe were carefully dissected away bluntly with tenotomy scissors and retracted carefully with vessel loops. The deep lobe of the parotid gland was then dissected away from the masseter muscle with the Harmonic scalpel. Stensen’s duct was divided between clamps and tied distally with 3-0 silk suture. The deep lobe of the parotid gland was dissected circumferentially away from any nerve branch and then excised completely and sent off the table to pathology with the tumor intact.

The parotid bed was copiously irrigated and made meticulously hemostatic with bipolar cautery. Any residual parotid tissue edges were cauterized with bipolar to prevent seroma formation. The superficial myoaponeurotic system was then dissected free from the skin flaps and sutured to the anterior border of the sternocleidomastoid muscle to close any parotid defect.

A 7-French closed suction drain was brought through a separate stab incision and secured to the skin with 2-0 nylon. The skin was then closed with interrupted 3 and 4-0 Vicryl and 5-0 nylon. A pressure Barton’s dressing was then placed. The patient was then awoken from anesthesia and extubated and taken to the recovery room in stable and awake condition.

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DATE OF OPERATION: MM/DD/YYYY

PREOPERATIVE DIAGNOSIS: Tumors of both ear lobes with associated deformity.

POSTOPERATIVE DIAGNOSIS: Tumors of both ear lobes with associated deformity.

OPERATION PERFORMED: Excision of tumors of ear lobes with reconstruction of the ear lobes.

SURGEON: John Doe, MD

ANESTHESIA: Xylocaine 1% with 1:100,000 adrenaline.

DESCRIPTION OF OPERATION: The patient was brought to the operating room and was placed in the supine position on the operating table. The ears were prepped with Betadine, and sterile draping was carried out. Attention was then directed to the right ear where there was a hard nodular tumor of the posterior ear lobe, near the auricular edge. This was excised by means of an elliptical excision around the mass and dissecting it free from the underlying subcutaneous tissue to the adjacent anterior skin of the lobule. Bleeding was controlled with Bovie cauterization, and the ear lobe was reconstructed suturing the skin edges together with 4-0 nylon interrupted sutures.

Attention was then directed to the left ear where there was a large nodular growth on the posterior surface of the tip of the ear lobe, and there was also a separation of the edge of the auricle just superior to the mass. Local anesthesia was infiltrated, and the mass was excised by means of an elliptical excision made on the posterior surface of the ear lobe. The dissection was carried to the anterior surface where the mass was attached, and a portion of the skin from the anterior ear lobe had to be sacrificed. The separation of the skin of the edge of the auricle was removed so that the edges could be approximated reconstructing the lateral edge of the auricle.

The anterior wound of the lobule was closed using 4-0 nylon interrupted sutures, and the posterior ear lobe was reconstructed along with the edge of the auricle using 4-0 nylon interrupted sutures. Polysporin ointment and sterile dressing covered by Tegaderm was placed over both the right and left ear lobes, and the patient left the operating room in stable condition.

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DATE OF OPERATION: MM/DD/YYYY

PREOPERATIVE DIAGNOSIS: Right maxillary sinus B-cell lymphoma.

POSTOPERATIVE DIAGNOSIS: Right maxillary sinus B-cell lymphoma.

OPERATION PERFORMED: Right maxillary antrostomy, endoscopic, with removal of tissue from the maxillary sinus.

SURGEON: John Doe, MD

ASSISTANT: Jane Doe, MD

ANESTHESIA: General endotracheal anesthesia.

ESTIMATED BLOOD LOSS: 50 mL.

SPECIMEN: Right maxillary sinus contents.

OPERATIVE FINDINGS: The patient had a large soft mass filling the right maxillary sinus.

COMPLICATIONS: None.

INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman with a history of right maxillary sinus mass. Biopsies in the office revealed a B-cell lymphoma. Plan today was to perform a maxillary antrostomy with removal of sinus mass prior to radiation therapy. The patient agreed to go ahead with the procedure. The risks and benefits were explained to the patient.

DESCRIPTION OF OPERATION: The patient was taken to the operating room and was placed in a supine position on the operating room table. General face mask anesthesia was given until a deep plane of anesthesia was obtained. At that point, endotracheal tube was placed by the anesthesiology service without difficulty. Afrin-soaked nasal pledgets were placed in the nares bilaterally for anesthesia and decongestion. After allowing time for decongestion, approximately 3 mL of 1% lidocaine with 1:100,000 epinephrine was injected into the middle turbinate and uncinate in the right nasal cavity. The patient was then draped in routine fashion.

A 0-degree nasal endoscope was used to visualize the right nasal cavity. There was a bulge of tumor from the right maxillary sinus below and above the inferior turbinate on the right. The left nasal cavity had no lesions or masses noted. Surgery began with medialization of the inferior third of the middle turbinate in the right nasal cavity under endoscopic assistance with the 0-degree nasal endoscope. This allowed visualization of the uncinate.

An uncinectomy was performed in routine fashion with backbiting forceps and the microdebrider. This allowed visualization of the right maxillary sinus tumor. Biting forceps were then used to remove tissue specimen from the right maxillary sinus for permanent specimen. A straight microdebrider was then used to remove the medial portion of the mass from the maxillary sinus.

A 45-degree nasal endoscope was then used with a curved microdebrider to remove the more lateral and inferior aspects of the maxillary sinus mass. A curved curette and 45-degree upbiting forceps were then used to dissect tumor from the posterior and superior and lateral walls of the maxillary sinus. This tissue was removed and sent for permanent pathology.

The very inferior extent of the tumor could not be reached with the sinus instruments. Due to the fact the patient had tumor bulging into the oral cavity, we did not want to remove this portion of the tumor to prevent an oroantral fistula. The patient will receive postoperative radiation therapy for his lymphoma, and it should treat the remaining tumor.

Gelfoam pledgets were then placed in the right maxillary sinus for hemostasis. The wound was thoroughly irrigated with approximately 200 mL of normal saline. There was good hemostasis at the end of the procedure. The nasopharynx was then suctioned of blood. The procedure was then terminated. The patient was awoken from general anesthesia, extubated, and sent to postanesthesia care unit in stable condition.

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DATE OF PROCEDURE: MM/DD/YYYY

PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma of the right neck, unknown primary.

POSTOPERATIVE DIAGNOSIS: Squamous cell carcinoma of the right neck, unknown primary.

PROCEDURES PERFORMED:
1. Direct laryngoscopy with biopsies.
2. Direct esophagoscopy.
3. Direct bronchoscopy.

SURGEON: John Doe, MD

ASSISTANT: Jane Doe, MD

ANESTHESIA: General endotracheal.

ESTIMATED BLOOD LOSS: Less than 10 mL.

SPECIMENS REMOVED: Right anterior vocal fold, right posterior glottis, right pyriform sinus, right tonsil, and right base of tongue.

PROCEDURE FINDINGS: The patient had no obvious site of primary disease.

INDICATION FOR PROCEDURE: The patient is a (XX)-year-old gentleman with a history of right neck mass, which was biopsied, positive squamous cell carcinoma. A PET-CT and physical examination was performed, which showed no evidence of primary disease. The plan was to take the patient to the operating room for direct laryngoscopy, esophagoscopy and bronchoscopy with biopsies.

DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and was placed in the supine position on the operating room table. An endotracheal tube was placed by the anesthesiology service without difficulty. The table was turned and the procedure began with direct laryngoscopy.

There were no lesions or masses noted in the tonsils, base of tongue, vallecula, epiglottis, bilateral pyriform sinus, aryepiglottic folds or false vocal folds. There was a small lesion in the right anterior true vocal fold less than 4 mm. There was a small area, less than 5 mm, of irregularity in the posterior glottic space in the right pyriform sinus. The decision was made to biopsy the right anterior true vocal fold, the right posterior glottic space, the right pyriform sinus, the right base of tongue and right tonsil. These were sent for frozen section diagnosis, and all were negative. Direct esophagoscopy was performed. There were no lesions or masses noted throughout the extent of the esophagus. Rigid bronchoscopy was then performed. Again, there were no lesions or masses noted in the proximal trachea down to the carina and the carina.

The endoscopes were then removed. There was no evidence of bleeding. The patient was awakened from general anesthesia, extubated and sent to the postanesthesia care unit in stable condition.

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DATE OF OPERATION: MM/DD/YYYY

PREOPERATIVE DIAGNOSIS: Right posterior neck mass.

POSTOPERATIVE DIAGNOSIS: Right posterior neck mass.

OPERATION PERFORMED: Right excisional biopsy of a posterior neck mass.

SURGEON: Jane Doe, MD

ANESTHESIA: Local anesthesia with MAC.

SPECIMENS: Right posterior neck tissue.

POSTOPERATIVE CONDITION: Stable.

COMPLICATIONS: None.

INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman with a right posterior neck mass. He states that it is painful to touch. He states that it has been there for over six months. The decision was made to go to the operating room for an excisional biopsy of right posterior neck mass. The risks and benefits of the procedure, including bleeding, infection and scar, were explained to the patient and he agreed to proceed.

DESCRIPTION OF OPERATION: The patient was taken to the operating room and was placed in the supine position on the operating room table. MAC anesthesia was given until a nice plane of anesthesia was obtained. At that point, 10 mL of 1% lidocaine mixed 1:1 with 0.25% Marcaine was injected around the right posterior neck lesion.

After allowing time for anesthesia and decongestion, a 3 cm horizontal incision was made over the neck lesion after the patient was prepped and draped in routine fashion. Dissection was carried down to the subcutaneous tissues. Posterior flaps were raised in a 360-degree fashion. Fibrofatty tissue, including lymphoid tissue, was removed from the area of the mass. No discrete large mass was identified. The patient certainly had scarring.

The wound was then thoroughly irrigated. Hemostasis was obtained with Bovie cautery. The wound was then closed in layered fashion, and 3-0 Vicryl stitches were used to reapproximate the tissues. Running 5-0 Prolene was used to reapproximate the skin. Bacitracin ointment was then placed. The patient was then awoken from MAC anesthesia and sent to the postanesthesia care unit in stable condition.

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PREOPERATIVE DIAGNOSIS: Left conductive hearing loss.

POSTOPERATIVE DIAGNOSIS: Left conductive hearing loss.

OPERATION PERFORMED: Left tympanoplasty with ossicular chain reconstruction and use of operating microscope.

SURGEON: John Doe, MD

ANESTHESIA: General.

ANESTHESIOLOGIST: Jane Doe, MD

INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female with a history of decreased hearing over the past couple of years. She has become much more aware of the hearing loss. She was found to have a conductive hearing loss in the left ear with absent reflexes. She was thought to have otosclerosis. The patient was given options, including use of hearing aid versus surgery versus monitoring. The patient decided to undergo surgical exploration.

OPERATIVE FINDINGS: The long process of the incus was actually eroded. There was a fibrous band between the top of the stapes and the body of the incus. The stapes superstructure was also not intact. The anterior portion of the arch was also slightly eroded with a very thin area of bone. For this reason, a stapedectomy was not performed, but instead a titanium TORP prosthesis was inserted. Cartilage was placed on top of this. The chorda tympani was preserved. The head of the malleus was removed and the incus was also removed. The head of the malleus was placed up into the epitympanic space.

DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. Intravenous sedation was performed, and the patient was prepped and draped in the normal sterile fashion. The microscope was draped in sterile plastic. The microscope was brought into the field. The microscope was used throughout the procedure in order to visualize the ossicular chain.

After the patient was prepped and draped in the normal sterile fashion, 1% lidocaine with 1:100,000 epinephrine was injected into the ear canal. A tympanomeatal flap was elevated. Bone was curetted from the posterior superior quadrant. The chorda tympani was preserved. At this time, we could visualize the ossicles, and we could see what the problem was. The problem was that the long process of the incus was a fibrous band. At this time, this fibrous band was not in continuity as palpation of the malleus revealed movement of the incus, but the stapes did not move. On further examination, we could see that the anterior arch of the curve was also very, very thin.

At this time, the fibrous band was cut. The incus was removed, and at first, we were going to put a PORP prosthesis in. However, we realized that it would not fit on top of the stapes because it would not support it, as it was abnormal. For this reason, the decision was made to put a TORP in. The TORP was measured. The head of the malleus was then cut off. We attempted to remove it, but it fell up into the epitympanic space, and we decided to leave it in this area. At this time, the TORP was measured and a 5.75 mm TORP prosthesis was selected. At this time, Gelfoam was packed in the middle ear space. Prosthesis was placed on top of the mobile stapes. The arch of the stapes was used to support the prosthesis. Gelfoam was packed around the prosthesis.

Tragal cartilage was obtained. This was cut and trimmed, and the perichondrium was removed. It was cut and trimmed to fit over the prosthesis. At this time, the cartilage was placed on top of the prosthesis. Gelfoam was packed around this. The eardrum was returned to its normal position. A piece of perichondrium was placed up underneath the eardrum to help support it in the posterior superior quadrant. At this time, the ear canal was packed with Gelfoam. The eardrum was then elevated again to check to make sure the cartilage was in the proper position, and it was. The ear canal was packed with Gelfoam. This was all done under the microscope. The patient was then awakened and taken to the recovery room in stable condition.

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PREOPERATIVE DIAGNOSIS: Left Meniere’s disease.

POSTOPERATIVE DIAGNOSIS: Left Meniere’s disease.

OPERATION PERFORMED: Left endolymphatic sac decompression and pressure equalizer tube insertion.

SURGEON: John Doe, MD

ASSISTANT:  None.

COMPLICATIONS:  None.

INDICATIONS FOR OPERATION: This is a (XX)-year-old gentleman who has classic Meniere’s disease with fluctuating hearing loss, principally low frequency, episodic vertigo, fullness and tinnitus, which he has had for approximately eight years but has gotten increasingly frequent vertiginous episodes, more violent and lasting longer. This is despite maximum medical treatment. An endolymphatic sac decompression was offered, and the risks and benefits of this were explained.

DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. After induction of general endotracheal anesthesia, the bed was rotated 90 degrees. The patient was prepped and draped in the usual fashion.

A postauricular incision, approximately 1 cm posterior to the postauricular crease, was performed and extended to the subcutaneous tissue exposing the musculoperiosteal layer. The musculoperiosteal layer was incised with a Bovie in a T-shape fashion. A periosteal elevator was used to expose the entire mastoid cortex. The spine of Henle was identified. A cortical mastoidectomy was performed using a 6 mm cutting bur. We had a rather well pneumatized mastoid with an anteriorly placed sigmoid. The sigmoid was identified. The antrum was entered. The posterior canal wall was thinned down to identify the facial nerve. The lateral canal was identified as was the posterior canal. Some retrofacial air cells were opened and the tegmen identified. A diamond stone was then used to skeletonize the sigmoid sinus in the region of the hard angle. The dura overlying the endolymphatic sac was then removed with the diamond stone, and he had a rather prominent endolymphatic sac.

With the sac decompressed, the wound was copiously irrigated. The musculoperiosteal layer was approximated with 3-0 Vicryl, and the postauricular incision closed with 3-0 Vicryl and Dermabond. The PE tube was then placed. A mastoid dressing was placed. The patient was awoken from general anesthesia and transferred to the recovery room having tolerated the procedure well.

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PREOPERATIVE DIAGNOSES:
1. Nasal septal deviation.
2. Bilateral inferior turbinate hypertrophy.

POSTOPERATIVE DIAGNOSES:
1. Nasal septal deviation.
2. Bilateral inferior turbinate hypertrophy.

OPERATION PERFORMED:
1. Septoplasty.
2. Bilateral inferior turbinate microdebrider submucosal resection and outfracture.

SURGEON: John Doe, MD

ANESTHESIA: General endotracheal anesthesia.

ESTIMATED BLOOD LOSS: 15 mL.

COMPLICATIONS: None.

OPERATIVE FINDINGS: Bony cartilaginous nasal septal deviation with 4+ inferior turbinate hypertrophy bilaterally.

INDICATION FOR OPERATION: The patient is a (XX)-year-old male with a history of chronic nasal obstruction. Office evaluation revealed nasal septal deviation with 4+ bilateral inferior turbinate hypertrophy. The patient has been treated with medical therapy, which has not resulted in improvement of his nasal obstruction. The risks, benefits, and alternatives of septoplasty and turbinoplasty were then emphasized on the risk of bleeding, infection, perforation, hyposmia and open nose syndrome were discussed with the patient who understood these risks and consented to the procedure.

DESCRIPTION OF OPERATION: After obtaining informed consent, the patient was brought to the operating room and placed supine on the operating table. General anesthesia with endotracheal intubation was induced without difficulty. The eyes were protected with ointment and tape. Cotton pledgets soaked in a solution of Pontocaine and ephedrine was inserted into both nasal cavities. Lidocaine 1% with 1:100,000 epinephrine was injected into the soft tissue of the septum and lateral nasal wall. The patient was prepped and draped.

A Killian incision was made in the left nasal cavity. Dissection was carried down to the quadrangular cartilage, and the left mucoperichondrial flap was elevated back to the bony septum. The cartilage was scored anteriorly with care to preserve at least 1.5 cm of dorsal and caudal cartilaginous strut. This was carried through to the contralateral side, and the right mucoperichondrial flap was elevated. A swivel knife was used to remove the large deviated portion of quadrangular cartilage, which was placed in saline for later use. Jansen-Middleton forceps were used to separate the superior and inferior portions of the bony septum posteriorly. A 4 mm osteotome was used to remove deviated portions off of the maxillary crest. Hemostasis was obtained at the bone cuts with monopolar suction Bovie electrocautery. The previously removed portion of quadrangular cartilage was trimmed, scored and straightened, and placed between the mucoperichondrial flaps. It was anchored in place with transseptal plain gut quilting suture. The initial mucosal incision was closed with interrupted chromic sutures.

Attention was then turned to the turbinoplasty. A stab incision was made in the face of the left inferior turbinate. A Freer elevator was used to dissect it posteriorly along the turbinate bone. Using a PK microdebrider blade, simultaneous submucosal resection and cautery of soft tissue and bone was performed. A Boies elevator was then used to outfracture the inferior turbinate. This procedure was repeated in identical fashion on the contralateral side. The Doyle silastic splints coated in antibiotic ointment were inserted into both nasal cavities and anchored in place with a transseptal nylon suture. The throat pack was removed, and the gastric contents were suctioned. The patient tolerated the procedure well without complications.

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PREOPERATIVE DIAGNOSIS:  Bilateral Reinke’s edema of the vocal folds.

POSTOPERATIVE DIAGNOSIS:  Bilateral Reinke’s edema of the vocal folds.

OPERATION PERFORMED:  Microsuspension laryngoscopy with excision of bilateral vocal fold Reinke’s edema with operating microscope.

SURGEON:  John Doe, MD

ASSISTANT:  Jane Doe, MD

ANESTHESIA:  General endotracheal.

ESTIMATED BLOOD LOSS:  Less than 5 mL.

SPECIMENS:
1.  Left vocal fold tissue.
2.  Right vocal fold tissue.

OPERATIVE FINDINGS:  The patient had large, boggy, polypoid Reinke’s edema bilaterally on the vocal folds.

DESCRIPTION OF OPERATION:  The patient came to the operating room and was placed in the supine position on the operating table. General face mask anesthesia was given until a deep plane of anesthesia was obtained. At that point, an endotracheal tube was placed without difficulty. Dedo laryngoscope was then used to visualize the larynx. Suspension was then performed.

An operating microscope was brought into the field to visualize the vocal folds. Approximately 0.1 mL of 1% lidocaine with 1:100,000 epinephrine was injected into the left and right vocal folds for decongestion. Afrin-soaked pledgets were then placed on the vocal folds without difficulty. The Afrin-soaked pledget was then removed. A sickle knife was then used to incise a lateral incision along the length of the left vocal fold. Frazier suction was then used to remove Reinke’s edema from underneath the lining of the vocal fold. Redundant tissue was excised with small scissors.

Attention was then turned toward the right vocal fold. Again, a sickle knife was used to incise a lateral incision along the length of the vocal fold. Suction was used to remove the Reinke’s edema from the vocal fold. Part of the Reinke’s edema was very scarred at that point, and left angled scissors was used to remove a portion of the epithelium of the vocal fold on the right.

At the completion of the procedure, Afrin-soaked pledgets were then again placed on the vocal folds. Dedo laryngoscope was taken out of suspension and removed. The operating microscope was removed. The pledget was removed prior to extubation. The patient was then extubated after awakening from anesthesia. The patient was sent to the postanesthesia care unit in stable condition.

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