DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Right vocal cord paralysis.
POSTOPERATIVE DIAGNOSIS:
Right vocal cord paralysis.
PROCEDURE PERFORMED:
Revision thyroplasty type I with Gore-Tex.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General and MAC anesthesia with 12 mL of 1% lidocaine with 1:100,000 epinephrine.
ESTIMATED BLOOD LOSS: Less than 10 mL.
SPECIMENS: None.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient came to the operating room and was placed in the supine position on the operating room table. The patient was given MAC anesthesia until a nice plane of anesthesia was obtained. At that point, approximately 12 mL of 1% lidocaine and 1:100,000 epinephrine was injected in the proposed incision site. The patient had a previous midline neck incision over the thyroid cartilage for excision of cricoid chondrosarcoma. This incision site was used. Local was injected deep to the level of the entire thyroid cartilage on the right. The patient also had approximately 1 mL of viscous lidocaine placed into the left naris. The patient also had Afrin nasal spray sprayed into the left nasal cavity.
After allowing time for anesthesia and decongestion, a flexible bronchoscope was placed into the left nasal cavity for visualization of the vocal cords. At that point, a 15 blade was used to incise the 4 cm incision over the right thyroid cartilage in horizontal plane. This was carried down deep to the strap muscles with Bovie cautery. A vertical incision was then made over the midline of the thyroid cartilage. The cartilage was identified. Perichondrium was elevated with a Freer elevator. This allowed visualization of the previous medialization window. The cartilaginous window was enlarged with a 2 mm diamond drill. The underlying perichondrium was then dissected free with a Freer.
At this point, visualization was obtained with the bronchoscope. This allowed visualization of the right paralyzed vocal fold. Gore-Tex was then used to perform the revision thyroplasty. The patient’s voice was tested until good vocalization was obtained. At that point, the Gore-Tex was sewn to the underlying strap muscles with a 2-0 Prolene stitch. Underlying strap muscles were reapproximated in the midline with 3-0 Vicryl stitches. The subcutaneous tissue was reapproximated with 3-0 Vicryl stitches, and the skin incision was reapproximated with 5-0 Monocryl. Mastisol and Steri-Strips were placed in horizontal plane for further coverage of the incision site. At that point, another 3 mL of 1% lidocaine with 1:100,000 epinephrine was injected into the wound region for further anesthesia. At that point, the bronchoscope was then removed from the patient’s airway and nasal cavity. The patient was then fully awoken from MAC anesthesia and sent to the postanesthesia care unit in stable condition.
