DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left mandibular abscess.
POSTOPERATIVE DIAGNOSES:
1. Left mandibular abscess.
2. Loose mandibular hardware.
3. Loose maxillary hardware, right.
OPERATION PERFORMED:
1. Incision and drainage of abscess.
2. Removal of implant, deep left mandibular compression plate.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 50 mL.
SPECIMENS:
1. Left mandibular plate.
2. Right maxillary plate.
OPERATIVE FINDINGS: The patient had a superficial abscess on the left border of the face and neck. Underlining the abscess was a loose screw and a mandibular plate. The patient also had an exposed plate in the right maxilla. The patient’s remaining body of the mandible was approximately 8 mm in height and depth.
DESCRIPTION OF OPERATION: The patient came to the operating room and was placed in the supine position on the operating room table. General face mask anesthesia was given until a deep plane of anesthesia was obtained. At that point, a nasotracheal tube was placed by the anesthesiology service without difficulty. The table was turned. The patient was prepped and draped in sterile fashion.
Mandibular-maxillary fixation was then performed with arch bars and wires. This was used to allow proper occlusion prior to the procedure. It was unclear whether the patient had a new nonunion. After completion of the arch bars, it was noticed that there was a small dehiscent plate in the right maxilla through the gingivobuccal mucosa. This was exposed with Bovie cautery. Plates were removed with screwdrivers. The screws were removed, and the plate was removed. The wound was sterilely irrigated with bacitracin-soaked normal saline. The wound was closed with 3-0 Vicryl stitches.
Attention was then turned towards the neck exploration on the left. The original incision was opened with 15 blade. Once the subcutaneous tissues were reached, the Bovie cautery was used to expose the left posterior anterior digastric muscle and the submandibular gland. Dissection was carried along the border of the submandibular gland and the left posterior digastric muscle to find the inferior border of the body of the mandible. Special attention was assayed deep to avoid entering the left marginal mandibular nerve. Due to the previous surgeries and the intense scarring, we were unable to identify the nerve. Mandibular edge was identified and followed anteriorly to the midline. The periosteum was raised over the left mandibular plate in previous nonunion site. The bone appeared to be intact and solid. There was no evidence of loose bone. The left mandibular plate did have loose screws posteriorly, which was approximately just deep to the patient’s abscess. The Synthes plate was then removed with screwdriver.
The wound was sterilely irrigated with normal saline containing bacitracin ointment. Hemostasis was obtained with Bovie cautery. Decision was made then not to replace the plate. Decision was also made not to do any bone harvest to block the left mandibular body. At that point, a #10 JP drain was placed in the wound. This was carried to the skin with 2-0 Prolene suture. The platysma muscle was reapproximated with 3-0 Vicryl stitches. The skin was closed with staples.
Attention was then turned towards the left abscess. Small incision was made to the skin allowing drainage of some purulent material and that wound was sterilely irrigated with bacitracin-containing normal saline. The abscess was then packed with sterile gauze. Drain was holding suction well. Bacitracin ointment was placed over the staple incision line. The mouth was then thoroughly irrigated with normal saline. At that point, the procedure was terminated. The patient was then awoken from general anesthesia, extubated, and sent to the postanesthesia care unit in stable condition.
