DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Facial lipoma.
POSTOPERATIVE DIAGNOSIS:
Facial lipoma.
PROCEDURE PERFORMED:
Excision of recurrent facial lipoma, right face.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 20 mL.
SPECIMENS: Right facial lipoma.
CONDITION: Stable.
COMPLICATIONS: None.
PROCEDURE FINDINGS: The patient had a large 4 cm lipoma overlying the temporalis muscle of the right face. This lesion had two large cystic components.
DESCRIPTION OF PROCEDURE: The patient came 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 approximately 7 mL of 1% lidocaine with 1:100,000 epinephrine mixed with 0.25% Marcaine was injected.
After allowing time for decongestion, an incision, slightly into the scalp and the lateral face, was made, approximately 4 cm in length, down through the subcutaneous tissues into the subcutaneous fat. Dissection was carried down with blunt scissors dissection and bipolar cautery down to the temporalis fascia. The mass was then identified on top of the temporalis fascia. Blunt dissection with scissors and bipolar cautery were carried beneath the mass along the temporalis fascia medially to the lateral border of the lateral orbital rim. Dissection was then carried superiorly and inferiorly to liberate this mass from the deep tissues. Dissection was then carried over the superficial portion of the mass. Careful dissection was used to make sure we were on the capsule of the mass to protect the frontal branch of the facial nerve. Nerve stimulation was used throughout the entire case, and the nerve never stimulated. The nerve was never visualized throughout the case. Dissection was carried anteriorly along the superficial part of the capsule to the lateral wall of the orbit. The mass then was released from the surrounding tissues and sent for permanent pathology. The size of the mass was 4 x 4 cm.
The wound was then thoroughly irrigated. Hemostasis was obtained with bipolar cautery. The wound was then sterilely irrigated. There was no evidence of bleeding. A small Penrose drain was placed and secured to the skin with 5-0 Prolene stitch. The wound was then closed in layered fashion. Deep layers were reapproximated with 4-0 Vicryl suture, and 5-0 Monocryl running subcuticular closure was then performed. Dermabond was used to reapproximate the skin. Dressing was placed once the Dermabond was dry. Paper tape was used to secure the dressing. The surgery was completed. The patient was then awoken from general anesthesia, extubated, and sent to the postanesthesia care unit in stable condition.
