PREOPERATIVE DIAGNOSIS: Hard palate neoplasm.
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.
