DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Hereditary hemorrhagic telangiectasia.
2. Epistaxis.
POSTOPERATIVE DIAGNOSES:
1. Hereditary hemorrhagic telangiectasia.
2. Epistaxis.
PROCEDURE PERFORMED: Nasal endoscopy with endoscopic control of epistaxis.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 200 mL.
PROCEDURE FINDINGS: Bilateral septal splints that migrated posteriorly. The patient had a moderate size anterior septal perforator with no evidence of crusting. Septal splints were replaced anterior to the septal perforation. There were numerous telangiectasias surrounding the nasal floor, middle turbinate, and inferior turbinate and posterior septum and choanae bilaterally. Moderate nasal hemorrhage on the right side, control with Bovie cautery and FloSeal.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old gentleman with a history of hereditary hemorrhagic telangiectasia, who has frequent epistaxis and has undergone numerous KTP laser surgeries. The patient had nasal splints placed most recently and at home had significant epistaxis. The patient was transported with bilateral nasal packing and was brought to the OR for packing removal and control of epistaxis.
DESCRIPTION OF OPERATION: After informed consent was reviewed with the patient, the patient was brought to the operating room and placed on the table in the supine position. Once a suitable plane of anesthesia was obtained by mask, the patient was endotracheally intubated by anesthesia personnel. Next, the patient was prepped and draped in standard fashion.
A right nasal balloon pack was deflated and removed. There was no significant bleeding. At this point, a 0-degree endoscope was used to visualize the right nasal cavity. There were significant telangiectasias. The septal splint had migrated posteriorly. Scissors were used to trim the Prolene stitch and the right septal splint was removed. There was significant brisk bleeding posteriorly. At this point, a combination of suction and irrigation was used to identify the bleeding. No pinpoint cause of bleeding was found.
Once the clot was removed, Afrin-soaked pledgets were instilled in the right nasal cavity. Next, a 0-degree endoscope was used to visualize the right nasal cavity. The septal splint was also migrated posterior to the anterior septal perforation. The septal splint was removed, and there was no further bleeding on the left side. Afrin-soaked pledgets were removed on the right nasal cavity, and there was no significant bleeding seen.
The nose was irrigated once again and with no active bleeding. New septal splints, fashioned by trimming the air port on a Doyle splint, were then inserted and sutured to the anterior septum with 4-0 Prolene with the knots on the right side. The endoscope was then reinserted to endoscopically visualize the nasal septal splint placement and further clot was suctioned from bilateral nasal cavities.
FloSeal 5 mL was instilled into bilateral nasal cavities in total, and the patient was turned over to anesthesia for extubation. The patient was successfully extubated in the OR and was stable upon transport to PACU.
