DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Chronic sinusitis with nasal polyps.
POSTOPERATIVE DIAGNOSIS: Chronic sinusitis with nasal polyps.
OPERATION PERFORMED:
1. Bilateral endoscopic revision total ethmoidectomy.
2. Computer image guidance.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
INDICATIONS AND DESCRIPTION OF OPERATION: The patient has a history of chronic nasal polyps with pansinus inflammation and nasal obstruction. He has undergone surgery twice in the past and presented with a very distorted intranasal anatomy and polypoid disease coming off both the nasal septum and the lateral wall. Therefore, it was felt that computer imaging was very important.
He was taken to the operating room and placed in the supine position. General anesthesia was induced with orotracheal intubation. Cotton pledgets soaked with Afrin were placed bilaterally in the nose. The patient was then draped in the usual fashion. The LandmarX headset was applied and the system was calibrated. This involved calibrating multiple points over the face and confirming its calibration. The wireless straight and curved suction instruments were also calibrated. The telescopes were then brought into the operative field, the pledgets removed, and the left side of the nose examined. There were polyps coming off the maxillary crest and upper septum. There was also polypoid disease laterally. Looking with the LandmarX system, the lacrimal bone was found, and although there appeared to be an antrostomy, this was not clearly visible due to polypoid disease. There appeared to be residual middle turbinate that had lateralized and was adhesed to the lateral wall.
One percent Xylocaine with 1:100,000 epinephrine was injected along the anterior septum and then on the lateral wall just over the lacrimal bone. The right side was then examined. On the right, there was also polypoid disease coming off the septum, but there appeared to be what looked like orbital fat protruding from the lateral wall. This was examined with the LandmarX system. There was thinning of the lamina papyracea, and there may have been a small defect, although it was not obvious, but nevertheless, this appeared to be tissue that contained fat. Pushing on the eye did not cause any protrusion, but the area was gently unroofed, and again, it appeared to be consistent with fat, and therefore, this was left alone throughout the case.
The left side was addressed initially using the straight Xomed shaver. The polypoid disease along the septum was resected. This was inferior and then more superior. This opened up the nasal cavity. The polypoid disease coming off laterally and residual lower middle turbinate was taken down, and using the LandmarX system confirmed a wide opening of the maxillary sinus into the nose. Some polypoid disease superiorly with the middle meatus was taken down and dissection then proceeded more posteriorly. There was polypoid disease posteriorly which, once removed, revealed a residual superior turbinate. Sphenoid ostium was found and exposed, and all gross polypoid disease was removed.
Attention was then directed to the right side. In a similar fashion, the polypoid disease was taken down off the septum both inferiorly and then more superiorly. The septum was noted to be deviated superiorly to the right. Dissection proceeded more posteriorly again. Residual superior turbinate was noted and polypoid disease was taken down in this location. The sphenoid opening was again noted and located. More anteriorly, the patient again had wide opening into the maxillary sinus, but this was not fully exposed because of what appeared to be protruding orbital fat.
At this point, Doyle splints were applied. The tube off of each splint was resected and just the flat portion of the splint was placed into each nasal cavity against the septum and secured with 4-0 Prolene. A neuro pledget with Afrin was then placed into each nasal cavity. The strings were brought out and secured to the nasal dorsum so that they could be removed prior to the patient’s discharge. The patient tolerated the procedure well without complications. He will be placed on vision checks and eye checks postoperatively during the recovery period. He was brought to recovery in stable condition.
