DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Nasopharyngeal respiratory papillomatosis.
POSTOPERATIVE DIAGNOSIS: Nasopharyngeal respiratory papillomatosis.
OPERATION PERFORMED: Endoscopic endonasal excision of nasopharyngeal respiratory papillomatosis.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 50 mL.
SPECIMENS: Respiratory nasopharyngeal papillomatosis.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman with a history of oropharyngeal and nasopharyngeal papillomatosis. The patient has persistent papillomatosis in the nasopharynx. The plan is to take the patient to the operating room for endoscopic excision of nasopharyngeal respiratory papillomatosis. The risks and benefits of the procedure were explained to the patient, and he agreed to proceed.
OPERATIVE FINDINGS: The patient had extensive respiratory papillomatosis in the nasopharynx originating from the nasopharyngeal side of the soft palate. The papillomatosis extended up to the torus tubarius bilaterally.
DESCRIPTION OF OPERATION: The patient came into 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 this point, an endotracheal tube was placed by the anesthesiology service without difficulty. At that point, Afrin-soaked nasal pledgets were placed in the nares bilaterally. After allowing time for decongestion, a 4 mm nasal endoscope was placed through the right nasal cavity without difficulty. The nasopharynx had an abundant amount of respiratory papillomatosis, originating from the nasopharyngeal side of the soft palate. This extended from the torus tubarius bilaterally down to the uvula.
A 4 mm curved Straightshot microdebrider was then used to remove the respiratory papillomatosis from the soft palate. Careful attention was paid to not damage the torus tubarius or the posterior pharyngeal wall. The entire extent of the papillomatosis was removed transnasally on the right and left sides under guidance of the 0-degree endoscope. A small amount of respiratory papillomas could not be accessed through this approach, so a transoral approach was performed with a Crowe-Davis mouth gag. A red rubber catheter was placed to the right nasal cavity and out through the oral cavity for retraction of the soft palate. A 45-degree nasal endoscope was used to visualize the papillomas on the nasopharyngeal side of the soft palate. Again, a curved Straightshot microdebrider was used to remove the papillomas.
A small amount of bleeding was controlled with suction Bovie cautery. After completion of the removal of the papillomatosis, 5 mL of cidofovir soaked on nasal pledgets was placed into the nasopharynx for topical absorption. Following five minutes, the nasal pledgets were removed. At that point, the surgery was completed. The patient was then awakened from general anesthesia, extubated, and sent to the postanesthesia care unit in stable condition.
