DATE OF OPERATION: MM/DD/YYYY
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.
