NAME: XXXX XXXXXX
MEDICAL RECORD #: XXXXXXX
DATE OF SURGERY: XX/XX/XX
SURGEON: XXXX XXXXXX, MD
ASSITANT: XXXX XXXXXX, MD
PREOPERATIVE DIAGNOSIS
Mandibular symphysis osteotomy. Open wound at floor of mouth and buccal mucosa.
POSTOPERATIVE DIAGNOSIS
Mandibular symphysis osteotomy. Open wound at floor of mouth and buccal mucosa.
PROCEDURE
Repair with internal fixation and repair of soft tissue defect.
ANESTHESIA
General.
OPERATIVE INDICATIONS
This is a youngster with a history of neuroblastoma whom I had first seen 6 months earlier. At
that time, the lesion presented as a neck mass, which was biopsied. Subsequent studies showed
extensive involvement of the right neck and right cranial base, namely extension into the jugular
foramen. The patient received neoadjuvant chemotherapy and is slated for radical en bloc
excision today.
OPERATIVE PROCEDURE
Through the mandibular-splitting approach, a radical neck dissection with en bloc resection of
the tumor from the cranial base around the jugular foramen was carried out without complication
after tracheostomy had been performed. The right floor of the mouth incision, extending from the
posterior middle third of the tongue up to the anterior floor of the mouth, was closed with
interrupted sutures of Vicryl, with care being taken to maintain a watertight closure. The
mandibular symphysis osteotomy was carried out through the socket of the extracted right
mandibular central incisor halfway down the vertical height of the symphysis and then stairstepped to the left and then down across the mandibular border. Care was taken to preserve both
mental nerves bilaterally. The horizontal portion of the osteotomy had necessarily coursed
through 2 tooth buds of the permanent dentition, and these were subsequently debrided. An
anatomic approximation of the symphysis was carried out and held in place while a 2.0
compression plate made of titanium was applied to the lower rim of the symphysis. Good solid
bony union was achieved. The mucosa, both labial and gingival of the lower lip were then
reapproximated with 5 interrupted sutures of Vicryl. The gingiva was then brought up to the
tooth crowns and secured into the mucosa in the anterior floor of the mouth with sutures. These
sutures encircled the teeth and created a nice watertight seal, with no exposure of the underlying
mandible. The lip was then prepared, and the remainder of the neck closure was carried out by
Dr. Fischer.
(continued)
OPERATIVE REPORT
NAME: XXXX XXXXXX
MEDICAL RECORD #: XXXXXXX
DATE: XX/XX/XX
Page 2
ESTIMATED BLOOD LOSS
Negligible.
COMPLICATIONS
None.
SPECIMENS
None.
_____________________________
XXXX XXXXXX, MD
XX/EC
D: XX/XX/XX
T: XX/XX/XX