# excision of left auricular cartilaginous appendage 11200??



## MELJNBBRB (Jun 16, 2015)

PREOP DX: congenital malformation of left auricle

                     SNHL




POSTOP DX: same




PROCEDURE: excision of left auricular cartilaginous appendage




SURGEON:  




ASSISTANT: None




ANESTHESIA: General endotracheal




FINDINGS: Root of the left auricular helix with a protruding cartilaginous appendage extending anteriorly towards the preauricular skin.  Small stalk of preauricular cartilage with overlying skin tag




INDICATION:  Pt is a 75 y.o. female with congenital auricular malformation of the left auricle and SNHL.  The location of the malformation was causing difficulty with hearing aid use to rehabilitate her known SNHL. She therefore opted for conservative excision to prevent interference with hearing aid use and minimize recurrent irritation.







Details of the procedure; its risks, benefits, and alternatives were discussed with the patient today. Informed consent was obtained.  Postoperative restrictions and limitations were also discussed. 







NARRATIVE:  After confirming that consent was obtained, the patient was taken to RRH OPERATING ROOM 4 and anesthesia was induced without difficulty.  Appropriate positioning was confirmed and a time-out conducted.  The left auricle was exposed and then prepped and draped in sterile fashion.




Skin of the preauricular region and the auricle at the base of the cartilaginous appendage was injected with a approximately 2 mL of 1% lidocaine with epinephrine.  An elliptical skin incision was delineated surrounding the pre-auricular malformation and extending to the root of the helix and around the cartilaginous appendage protruding from the root of the helix.




Skin was incised with a #15 blade. Sharp dissection was performed through the subcutaneous tissues to identify the cartilage underlying the preauricular lesion.  This was then amputated immediately anterior to the root of the helix. The skin overlying the base of the cartilage protruding from the helical root was elevated off of the underlying cartilage which was then also amputated near its origin.  The excised specimen was delivered in formalin.




The wound was then liberally irrigated with saline and hemostasis within the wound was confirmed.  The resultant stellate incision was then closed in layers.  Deeper layers were closed with vicryl suture and the skin was reapproximated with chromic gut suture.  Incision was dressed with antibacterial ointment and a Glasscock dressing was placed over the left auricle.




The patient was returned to the anesthesia team and she emerged without complications. She showed full facial nerve function in all branches in the recovery room.













EBL: minimal




FLUIDS: Per anesthetic record




DRAINS:  None




SPECIMENS: left auricular malformation for permanent pathology




DISPO: To PACU in stable condition.


path: BRIEF CLINICAL HISTORY
 Left auricular deformity.


GROSS:
 Specimen labeled left auricular deformity is a 3.2 x 1.2 x 0.7 cm
 unoriented ellipse of tan skin with a 1.3 x 1.0 cm white-pink soft
 nodule.  Separate in the container is a 1.4 x 0.8 x 0.7 cm unoriented
 ellipse of tan skin with a 0.8 x 0.6 x 0.9 cm tan-pink wrinkled soft
 nodule with an underlying tan-white firm, rubbery possibly cartilaginous
 area.  Entirely submitted in 1A-1C-first ellipse, 1D-1E-second ellipse.

LMG/sc

MICROSCOPIC DIAGNOSIS:
 Skin, left auricle, excision: Benign skin with underlying cartilage.


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## WANDERSON (Jun 19, 2015)

I think I would look at the lengths in the pathology note since they were not posted in your doc's note.  I would then go to the benign lesion removal codes.  That is what I would code it as.


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## MELJNBBRB (Jun 19, 2015)

thank you so very much for your time and reply


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## WANDERSON (Jun 22, 2015)

Your welcome, hope it works for you!!


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## jackjones62 (Jun 23, 2015)

Just an FYI, Pathology measurements are not exact as the specimen shrinks when placed in formalin, use them as a guide, I have always rounded up the number slightly if the surgeon fails to indicate size; Wanderson is correct, go for the excision of benign lesions, I would use 11446 as well as the layered closure, 12052.

Jennifer
CT ENT


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## Kelly_Josephine (Sep 23, 2016)

Does anyone have a citation for using benign skin lesion here?


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