DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Nasal bone fracture.
2. Nasal obstruction.
3. Turbinate hypertrophy.
POSTOPERATIVE DIAGNOSES:
1. Nasal bone fracture.
2. Nasal obstruction.
3. Turbinate hypertrophy.
OPERATION PERFORMED: Closed reduction of nasal bone fracture with stabilization, septoplasty and bilateral inferior turbinate reduction.
SURGEON: John Doe, MD
ANESTHESIA: General orotracheal intubation.
ESTIMATED BLOOD LOSS: Less than 25 mL.
INDICATION FOR OPERATION: The patient is a (XX)-year-old female, who is referred with a chief complaint of nasal bone fracture. She sustained trauma to the nose, which resulted in an obvious nasal deformity. It was elevated on the right and depressed on the left. Intranasally, she fractured the nasal septum causing nasal obstruction and she had hypertrophic turbinates. We evaluated the patient. We gave the patient the option of continuing with the current condition or recommended surgery to correct the nasal deformity, the nasal fracture, septal deformity, the nasal obstruction and the turbinate hypertrophy. We explained all possible risks and possible complications to the patient. The patient stated she understood and consented for the procedure.
DESCRIPTION OF OPERATION: The patient was brought to the room and was draped and sterilized in the usual fashion in the supine position. When adequate anesthesia was given by anesthesiologist, we injected 1% lidocaine, 1:100,000 epinephrine. A total of 10 mL were used, 5 mL on each side of the nasal septum. We then placed two pledgets in the nostril soaked in 10% cocaine. We let it stay there for approximately 5 minutes and removed it. We then used the #15 blade and made a caudal incision on left-hand side, elevated the mucoperichondrial junction on the left-hand side, going from anterior to posterior all the way past the bony cartilaginous junction, all the way to the bone plate. Dissected from anterior to posterior and from superior to inferior over the bony maxillary crest, and over the nasal septal fracture without any difficulty. We did not cause any perforations.
We then made a crossover incision approximately 1.5 cm distal to the caudal incision. We elevated the mucoperichondrial junction on the opposite side in the same fashion as previously described. We then used Knight scissors and dissected down the midline and removed the deviated portions and the fractured portions of the cartilaginous and bony septum. Once that was completed, we then suture closed the incision with 4-0 chromic placing one on the inferior, medial and superior aspects. We then used the XTS 3000. It was on 5000 oscillating RPMs. We used the submucous resection turbinate blade. We started at the most anterior aspect of the inferior turbinate, going all the way posterior to the end of inferior turbinate, which is called the Mulberry tip. We performed a submucous resection. We then performed a therapeutic fracture of the remaining portions of the bony aspect of the inferior turbinate, fracturing it laterally. That was performed on the right side. The exact same procedure was then performed on the left side.
Once that was completed, we then manually refractured the patient’s nose and placed it in the normal anatomical position. We then used two layers of Steri-Strips externally on the nose. We placed a thermoplastic cast externally, which supported the bones in the normal anatomical position. We packed the nose with two Telfa rolled up in a cigarette fashion, placed intranasally for a split intranasally. We then placed a mustache dressing. Once that was completed, the patient was then awakened and transferred to the recovery room in stable satisfactory condition.
