DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right lingual nerve anesthesia, status post extraction of wisdom tooth.
POSTOPERATIVE DIAGNOSIS: Right lingual nerve anesthesia, status post extraction of wisdom tooth with lateral neuroma and adherence to the lingual periosteum of the right mandible.
OPERATION PERFORMED: Microscopic external decompression of right lingual nerve.
SURGEON: John Doe, MD
ANESTHESIA: General nasotracheal.
ESTIMATED BLOOD LOSS: Less than 100 mL.
FLUIDS: Approximately 1 L crystalloid.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed in the supine position on the operating room table. After induction of general anesthesia and intubation with a nasotracheal tube, the patient’s head and neck were prepped and draped in the usual sterile fashion using Betadine scrub and sterile linen. Attention was directed intraorally, where approximately 6 mL of 0.5% Marcaine with epinephrine, 1:100,000 was injected into the lingual vestibule of the right side of the floor of the mouth. A #15 Bard-Parker blade was then used to make a longitudinal incision starting approximately one-half way up the ascending ramus on the anterior border down to the distal buccal aspect of tooth #31. A crevicular incision was then made on the lingual aspect of all teeth on the right side to tooth #27. A similar crevicular incision was made to tooth #29 on the buccal aspect. Subperiosteal dissection was then carried out on both buccal and lingual area, and the lingual nerve was readily visible at the superior aspect of the incision.
A blunt dissection was then taken along the lingual nerve as it coursed inferiorly and towards the area of the previously extracted third molar. Once this site was encountered, a large amount of scar tissue was encountered and it was evident that the lingual nerve was tightly adherent to the lingual periosteum and the mandible and nearly indiscernible from the scar tissue, which surrounded it. The microscope was then brought in, and under both loupe magnification and alternating between loupe magnification and operating microscope, the nerve was dissected free of scar tissue in the area. This was performed until the nerve was totally free of any fibrous tissue.
Once the nerve had been freed up under the operating microscope, the scar tissue which was adherent to the nerve itself was then carefully teased away and sharply dissected away using microscissors. This left the nerve intact and clean of fibrous tissue. Direct and microscopic evaluation of the nerve with transillumination did not appear to show any types of internal neuroma and the nerve indeed appeared to be in quite good shape. The decision was made that no attempts to reanastomose would be made since we felt that chances of return of some sensation were excellent by simply decompressing the nerve.
The area was copiously irrigated and hemostasis was verified. A small piece of Surgicel was used to buffer the lingual nerve from rubbing directly against the mandible. The area was then closed in an interrupted fashion using 3-0 plain gut sutures. The patient tolerated the procedure well, was awakened, extubated, and brought to the postanesthesia care unit in stable condition.
