DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Prominent nose with dorsal hump.
2. Septal deviation.
POSTOPERATIVE DIAGNOSES:
1. Prominent nose with dorsal hump.
2. Septal deviation.
OPERATION PERFORMED: Septorhinoplasty.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMEN: Discarded.
DESCRIPTION OF OPERATION: The patient was seen in the preoperative area, and in the sitting position, the nasal skin was wiped with alcohol and marked with a marking pen for surgery. The patient was then brought into the operating room, placed supine on the operating table and administered general anesthesia successfully. Local anesthesia was infiltrated along the septum, dorsum of the nose and along the lateral alar cartilages. Neo-Synephrine dampening cottonoid pledgets were placed bilaterally. The nose and face were prepped and draped in the usual sterile fashion. Incision was then performed along the leading edge of caudal septum on the right side and septal mucosal flaps were raised bilaterally back into the bony septum. The septum was scored approximately 1 to 1.5 cm back from the caudal edge. Using a swivel knife, the central segment of the septum was then excised. This was then placed in the cartilage crusher, tapped once to soften it and straighten it and then edges were trimmed. It was then replaced within the defect.
There was a prominent spur along the left basal palate and this was then excised. The septal incisions were closed with 5-0 chromic interrupted suture. Antibiotic-coated Reuter bivalve splints were then placed bilaterally after trimming the splints slightly smaller and a single mattress suture with 4-0 chromic gut was then placed to secure the edges together. Bilateral nasal alar rim incisions were then performed bilaterally and soft tissue was elevated off to the lower lateral alar cartilage on each side. A 4.5 mm rim strip was left.
The upper half of the ala was then excised by a cephalic resection. Soft tissue was then elevated up off the dorsum of the cartilage and bony bridge. Rasping was then done with bony part of the hump with a #5 rasp. The prominent part of the septum was then taken down with a septal rasp followed by a 15 blade. We brought this down about 3 mm. This extended down to the cartilage edge of the septum. It was checked after pressing out any edema and some additional rasping was then performed minimally along the rasped edge of the bone in order to soften it slightly.
Hemostasis was obtained using cautery. Inner mucosal repair along the alar rim incision was then completed with 5-0 chromic interrupted sutures bilaterally. The skin of the nose was then cleaned, dried and dressed with skin prep followed by taping, followed by external splint. Cottonoid pledgets were removed and nasopharynx was aspirated dry. The patient tolerated the procedure well. No apparent complications. The patient was then extubated in the operating room and transferred to the recovery room in satisfactory condition postoperatively.
