# Stair-step lengthening



## KELLI (Nov 18, 2010)

Wondering if dx: 754.1
with cpt code: 21899 (unlisted code ??????)
                      64613
                      14040
Is appropriate for the op report below??
PREOPERATIVE DIAGNOSIS:  Right neck sternocleidomastoid torticollis.

POSTOPERATIVE DIAGNOSIS:  Right neck sternocleidomastoid torticollis.

PROCEDURE PERFORMED:  Stair-step lengthening of right neck
sternocleidomastoid torticollis using chemodenervation of muscle
using botulism toxin type A and local adjacent tissue transfer
closure of neck skin.

SURGEON:  Eric Stelnicki, MD

DESCRIPTION OF PROCEDURE:  Under general anesthesia, the patient was
prepped and draped in a sterile fashion.  A nerve stimulator was used
throughout the case to identify and derange the spinal accessory
nerve.  No paralyzation was noted throughout the case.

A 15-blade scalpel was used to make a W-plasty incision in the neck
to prevent straight line contracture during the healing.  The
external jugular was identified and carefully retracted as well as
the platysma.  The sternocleidomastoid was identified.  The
sternocleidomastoid was separated from the surrounding fascia with
care taken not to damage the internal jugular or the spinal accessory
nerve.  A nerve stimulator was used throughout the case to make sure
that there was no damage to the nerve.

Following this, meticulous hemostasis was obtained.  The muscle was
elevated and a 3.5-cm stair-step lengthening of the
sternocleidomastoid was performed.  It was sewn together with a
modified Kessler stitch as well as an epimysial stitch using 0
Vicryl.  The W-plasty was then closed, closing the platysma and any
overlying skin in the W-plasty pattern.  Chemodenervation was
performed at the end of the case.

The patient tolerated the procedure well with no complications.  The
patient was sent to recovery in good condition.


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