PSReport 0706 PATIENT NAME: MR #: SURGEON: DATE OF SURGERY: Cynthia Mancini 059-332 Jack C. Einhorn, MD 03/10/2014 PREOPERATIVE DIAGNOSES 1. Chronic nasal obstruction secondary to septal deviation. 2. Turbinate hypertrophy. POSTOPERATIVE DIAGNOSES 1. Chronic nasal obstruction secondary to septal deviation. 2. Turbinate hypertrophy. NAME OF OPERATION 1. Septoplasty. 2. Submucous resection of inferior turbinates bilaterally. ANESTHESIA General via endotracheal tube. INDICATIONS The patient is a 35-year-old woman with a history of chronic nasal obstruction for the past several years. Her symptoms were refractory to multiple medical therapies. FINDINGS C-shaped deflection of the nasal septum to the left side with approximately 80% obstruction of the left naris. In addition, there was a right maxillary crest spur with approximately 60% obstruction of the right nasal passage. The inferior turbinates were hypertrophied bilaterally. PROCEDURE After adequate general endotracheal anesthesia had been achieved, the patient was placed in supine position. A 4% cocaine solution was applied topically, and 2% Xylocaine with 1:100,000 epinephrine was injected subcutaneously to assist with local hemostasis. The patient was prepared and draped in the usual sterile fashion. The inferior turbinates were out-fractured bilaterally. A left hemitransfixion incision was made, and carried through the underlying septal cartilage. A left mucoperichondrial flap was elevated. Quadrilateral cartilage was incised at its point of maximal deflection, and bilateral mucoperiosteal flaps were elevated. The deviated portions of the perpendicular plate of the ethmoid were removed using septal scissors and rongeurs. Overlapping inferior quadrilateral cartilage was incised. The right maxillary crest and vomerine spur were removed using Takahashi forceps. Additional septal cartilage was trimmed to allow the C-shaped deformity to be corrected. Inspection revealed correction of the nasal septal deformity. Patent nasal airways were present bilaterally. Plain gut 4-0 was used to place a (continued) OPERATIVE REPORT PATIENT NAME: Cynthia Mancini MR #: 059-332 DATE OF SURGERY: 03/10/2014 Page 2 running plication suture to approximate the right and left nasal mucosa. Interrupted 4-0 chromic was to close the hemitransfixion incision. The inferior turbinates were in-fractured bilaterally. The anterior and inferior aspects of the inferior turbinate mucosa were cauterized and incised. The mucosa was elevated off the medical and lateral aspects of the inferior turbinate bone. The inferior turbinate bone was then resected using Takahashi forceps. Redundant mucosa was also excised sharply. Hemostasis was achieved using suction and Bovie cautery. After hemostasis was assured, Telfa impregnated with 1% hydrocortisone cream was placed in the nasal cavity bilaterally as nasal packing. A drip pad was placed and the procedure terminated. The patient tolerated the procedure well. ESTIMATED BLOOD LOSS 10-15 mL. COMPLICATIONS None. ___________________ Jack C. Einhorn, MD JCE/ps D: 03/10/2014 T: 03/10/2014