DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Cushing’s syndrome.
POSTOPERATIVE DIAGNOSIS: Cushing’s syndrome.
OPERATION PERFORMED: Sublabial transseptal sphenoidotomy for approach to pituitary gland and closure.
SURGEON: John Doe, MD
INDICATIONS FOR OPERATION: This is a gentleman with elevated hormone levels, recommended for hypophysectomy by the neurosurgical service. This note will include the approach and closure through a sublabial transeptal sphenoidotomy.
DESCRIPTION OF OPERATION: The patient was placed in the supine position under general anesthesia by endotracheal tube. Following placement in the “crown of thorns” by the neurosurgical service, the C-arm was used to get an accurate crosstable of the planum and sella. The nose was prepped with Betadine and draped sterilely. Xylocaine 1% with epinephrine was injected into the septum as well as in the sublabial area.
A sublabial incision was made, and the lip was degloved off the free maxilla from canine to canine up over the maxillary sinus and 1.5 cm above the floor of the nose. The periosteum was elevated off each side of the floor, and the perichondrium was elevated off the left side. The caudal septum was swung into the right side while an incision was made in the septum, and a piece of the perpendicular plate of the septum was kept for later closure. The posterior septum was resected with Jansen-Middleton and pituitary forceps. The pituitary speculum was brought into position. Its position was confirmed by the C-arm to show a good direction to the sella. The rostrum of the sphenoid was taken down, and the sphenoid sinus was opened bilaterally. The intersphenoid septum was partially removed and left intact for neurosurgical landmarks. The mucosa was stripped from the sphenoid sinuses. The procedure was turned over to the neurosurgeons with the sella under direct view and C-arm x-ray showing good anterior and posterior extent of reach.
Following completion of the neurosurgical procedure and obliteration of the sphenoid sinus, the procedure was taken back by this service. There was some bleeding from the floor near the septal artery, and this was cauterized. The septal leaves were returned to the midline, and the Doyle splints were placed and sutured with 4-0 nylon. Two pledgets were placed in each side of the nose and sutured through and through the septum. The septum was sutured to the nasal spine using 4-0 nylon. The oral incision was closed using 3-0 chromic. The patient tolerated the procedure well. Estimated blood loss for the ENT portion of the procedure was approximately 150 mL.
