ASSISTANT:
ANESTHESIOLOGIST:
MARK KENTER, M.D.
PROCEDURE:
1.
Microscopic bilateral myringotomy and PE tubes.
2.
Tonsillectomy.
3.
Adenoidectomy.
PREOPERATIVE DIAGNOSIS: Chronic bilateral serous otitis
media, enlarged tonsils and adenoids blocking the
eustachian tubes.
POSTOPERATIVE DIAGNOSIS: Chronic bilateral serous otitis
media, enlarged tonsils and adenoids blocking the
eustachian tubes.
ANESTHESIA:
General.
OPERATIVE FINDINGS: Patient with chronic bilateral serous
otitis media, enlarged tonsils and adenoids.
OPERATIVE PROCEDURE: After adequate endotracheal
anesthesia was accomplished, the left ear was visualized
using an aural speculum and operating microscope. With
microscopic visualization the canal was cleaned of cerumen.
With microscopic visualization an anterior inferior
myringotomy incision was performed. Thick serous fluid was
aspirated from the middle ear and PE tube was placed for
ventilation purposes. The head was turned and the right
ear was visualized, again with aural speculum and operating
microscope the tympanic membrane was visualized. An
anterior inferior myringotomy incision was performed.
Thick serous fluid was aspirated from the middle ear and PE
tube was placed for ventilation purposes.
The head was turned to the midline. A McIvor mouth gag was
placed to hold the mouth open. A red rubber catheter was
placed into the nose and brought out through the mouth to
retract the soft palate. The left tonsil was grasped with
a tenaculum. Using a Peak Plasma coagulating blade an
incision was made in the anterior pillar, superior pole.
The tonsil was dissected beneath the capsule extending to
tonsillar fossa from superior to inferior, anterior to
posterior, across the inferior pole, separating it from the
posterior pillar, leaving it intact. Bleeding was
controlled with Peak cautery and electrocautery. Marcaine
0.25% with 1:200,000 epinephrine was used for local
infiltration of tonsillar fossa. The right tonsil was
grasped with a tenaculum. Again, using a Peak, incision
was made in the anterior pillar, superior pole. The tonsil
was dissected beneath the capsule, extending to the
tonsillar fossa from superior to inferior, anterior to
posterior, across the inferior pole, separating it from the
posterior pillar, leaving it intact. Bleeding was
controlled with Peak cautery and electrocautery. Marcaine
0.25% with 1:200,000 epinephrine was used for local
infiltration of the tonsillar fossa.
The nasopharynx was visualized with laryngeal mirror.
Adenoids were removed with Peak adenoid cauterizing curets
and bleeding was controlled with electrocautery. The red
rubber catheter was removed and the nasopharynx was
thoroughly irrigated with saline. The McIvor mouth gag was
removed. The patient tolerated the procedure well.