DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Graves disease with Graves ophthalmoplegia.
POSTOPERATIVE DIAGNOSIS: Graves disease with Graves ophthalmoplegia.
OPERATION PERFORMED: Endoscopic orbital medial wall decompression.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 100 mL.
SPECIMENS: None.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position on the operating table. General face mask 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 procedure began with injection of 6 mL of 1% lidocaine with 1:100,000 epinephrine into the uncinate and middle turbinate. Afrin-soaked nasal pledgets were placed in the nares bilaterally. After allowing time for anesthesia and decongestion, the patient was prepped and draped in a routine fashion. The Afrin-soaked nasal pledgets were removed.
The procedure began with identification of the uncinate after medialization of the middle turbinate. The uncinate was taken down with the pediatric backbiter. A 4 mm Straightshot microdebrider was then used to remove the rest of the uncinate. This allowed visualization of the natural os of the maxillary sinus. This was enlarged with the Straightshot microdebrider posteriorly to the posterior antral wall and superiorly to the inferior floor of the orbit. Anterior and posterior ethmoidectomy were then performed with the Straightshot microdebrider. The tissue was removed along the medial wall of the orbit up to the skull base. A small dehiscence in the lamina papyracea was identified and a sinus seeker was used to infracture the bone of the lamina papyracea. This infracture was carried inferiorly from the medial border of the inferior floor of the orbit superiorly to the skull base, posteriorly to the annulus of the orbit and anteriorly to the nasolacrimal canal. Once the lamina papyracea was removed, a sickle knife was then used to incise the periorbita. Three incisions were performed from posterior to anterior superiorly in the midline and on the inferior exposed portion of the periorbita. Endoscopic scissors was used to incise the anterior and posterior periorbita and the periorbita was removed. This allowed excellent decompression of the orbital fat into the sinus cavity.
Hemostasis was then obtained with irrigation with warm saline. FloSeal, approximately 5 mL, was then placed in the nasal cavities for completion of hemostasis. The nasopharynx was suctioned. There was no evidence of further bleeding. At that point, the procedure was terminated. The patient was then awakened from general anesthesia, extubated and sent to the postanesthesia recovery unit in stable condition.
