# Floor of mouth carcinoma---op note



## daknaack (Jan 21, 2013)

I am having a real challenge trying to code this op.  Any help/suggestions would be greatly appreciated....

OPERATIVE PROCEDURE PERFORMED: 
Wide local excision of floor of mouth carcinoma with partial excision of the left 
sublingual gland and rerouting of the left submandibular duct. 

Patient was taken to the operating room and after induction of general anesthesia, the lesion
on the floor of mouth was examined. Lesion was about 1 cm posterior to the opening for 
the submandibular duct and it was right along the ridge of the sublingual gland. I was 
able to cannulate the submandibular duct with a lacrimal probe and dilated the duct up to 
a number 2 lacrimal probe. I then marked an incision about the lesion in the floor of 
mouth providing for about 1 cm of normal appearing tissue about the entire lesion. Once 
this was completed I then infiltrated the floor of mouth with 1% lidocaine with 
epinephrine. I made the incision around this lesion and anteriorly in the region of 
the submandibular duct I had to make the apex of the incision just beyond the 
submandibular duct opening and therefore I then dissected the submandibular duct from the 
attachment to the mucosa on the floor of the mouth and then retracted that duct 
posteriorly away from the sublingual gland and the tissue which was to be excised. As I 
completed the fusiform incision along the anterior and posterior margins of the lesion. 
They then met about 1 cm to 1.5 cm posterior to the posterior aspect of the lesion and 
then I developed a deep margin along the sublingual gland and a portion of the sublingual 
gland was excised together with the abnormal mucosa to provide for an adequate deep 
margin around this lesion. 
Once the lesion was removed completely, it was then sent for frozen inspection analysis. 
There was squamous cell carcinoma noted within the specimen but all margins including the 
deep margin were clear of any cancer. There was some microscopic invasion noted on the 
biopsy. I therefore elected to close the floor of the mouth primarily. First of all I 
made an incision along the length of the submandibular duct for the distance of about 8 
to 10 mm. This allowed me to then marsupialize the duct and reroute it in a location 
just posterior to where it had originally exited into the floor of mouth. I closed the 
floor of mouth posterior to this area with 4-0 Chromic suture and then as I came up to 
the location where I planned to reroute the duct I began to suture the duct to the 
surrounding mucosa. This allowed for marsupialization of the duct in this area. I then 
closed the mucosa anterior to where the duct had been rerouted to and was satisfied with 
the closure at this point. 
Once the closure had been completed the patient was awakened from anesthesia, extubated 
and taken to the recovery room in stable condition.


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## mdmoney (Jan 29, 2013)

41116 Excision, lesion of floor of mouth (Includes primary closure)
42450 Excision of sublingual gland (includes primary closure)

Those are my thoughts...


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