DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Chronic sinusitis.
2. Nasal airway obstruction.
3. Turbinate hypertrophy
POSTOPERATIVE DIAGNOSES:
1. Chronic sinusitis.
2. Nasal airway obstruction.
3. Turbinate hypertrophy
OPERATION PERFORMED:
1. Radiofrequency reduction of bilateral inferior nasal turbinates.
2. Septoplasty.
3. Bilateral endoscopic sinus surgery consisting of bilateral anterior and posterior ethmoidectomy.
4. Bilateral maxillary antrostomy with tissue removal.
BLOOD LOSS: 25 mL.
COMPLICATIONS: None.
ANESTHESIA: General endotracheal.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed upon the table in supine position. After successful general endotracheal anesthesia was established, an oropharyngeal pack was placed. VTI unit was brought into place, registered, and verified. We placed 1% Xylocaine with 1:100,000 epinephrine and cocaine bilaterally intranasally. The patient was draped. We injected 3 mL of saline into the hypertrophic left inferior turbinate and placed 300 joules of radiofrequency energy posteriorly and 300 joules anteriorly. We placed 3 mL of saline into the hypertrophic contralateral inferior turbinate and placed 300 joules of radiofrequency energy posteriorly and 300 joules anteriorly.
We then made a standard left Killian incision. The mucoperichondrium and mucoperiosteal flaps were elevated. The quadrangular cartilage was disarticulated from the bony septum posteriorly. The obstructing portion of the bony septum was conservatively resected. A thin strip of inferior quadrangular cartilage was resected. Superior relaxing incisions were made. Both inferior turbinates were laterally outfractured. These maneuvers greatly improved the patient’s airway. Plain suture on a Keith needle was used circumferentially to reapproximate the mucoperichondrial flaps. Two of these sutures were placed. The Killian incision was closed with 4-0 chromic in a running fashion.
We then proceeded with the endoscopic sinus surgery portion of the procedure. We used a combination of 0-degree and 7-degree telescopes. We used the VTI and gentle pressure on both globes throughout the procedure. In the left nasal airway, the uncinate process was incised using sharp sickle knife and infundibulotomy was carried out. The anterior and posterior ethmoidal cells were exenterated of thickened mucosa. The natural ostia of the maxillary sinus were identified. It was enlarged at the expense of the posterior fontanelle, avoiding the nasolacrimal duct, and it was cleared of thickened mucosa. The nasal frontal recess was cleared of thickened mucosa.
On the contralateral side of the nose, the uncinate process was incised using sharp sickle knife and infundibulotomy was carried out. The anterior and posterior ethmoidal cells were exenterated of thickened mucosa. The natural ostia of the maxillary sinus were identified. It was enlarged at the expense of the posterior fontanelle.
A large cyst filling in the right maxillary sinus was unroofed. Thick mucoid drainage was cleared from the sinus. There was no evidence of purulence. All the ethmoid sinuses have been exenterated. The nasal frontal recess was exenterated. All of the diseased tissue had been removed. Lamina papyracea were intact as was the cranial floor. There was no cerebrospinal fluid seen throughout the procedure. Merogel packs were placed in the area of the ethmoidectomies. Telfa and bacitracin were placed bilaterally intranasally. The previously placed oropharyngeal pack was removed. Blood loss was estimated at 25 mL. There were no surgical complications.
