kbrasher12@icloud.com
Contributor
New to ENT coding and this seems more complicated than a regular rhinoplasty. Thanks!
After the induction of local anesthesia and prepping and draping in the usual
manner, nasal stenosis was first addressed. This was opened using a Bard 15
blade and we would proceed at the end of the procedure, inserting a Reuter
stent in the area to hold this opened for 3 weeks at least.
Intercartilaginous incisions were made bilaterally. These incisions were
extended into the nasal septal area only approximately 1-1.5 cm. Everything
was undermined over the dorsum and the lateral wall on the right side. Left
side was undermined as well. Suspension sutures were used to elevate the
upper lateral cartilage on the left side using 5-0 PDS pulling this up to the
dorsum of the nose and sutured in place at the septal angle. One suture was
used. Perforating osteotomies were done bilaterally. Nasal bones were
infractured. This gave some semblance of symmetry. There was still the
asymmetry on the right side with the caved in nasal bone even though we did
lift this out. I elected to proceed with a Gore-Tex graft. Gore-Tex was cut
to proper size, soaked in bacitracin. Bacitracin was injected into the wound
and the Gore-Tex graft was slid into place perfect fit. The incision sites
were closed using interrupted 4-0 chromics throughout the entire range. This
gave the desired result. Bilateral submucous turbinoplasty with
cauterization, dissection, resection, outfracturing was carried out without
difficulty.
So, in summary, we did open reduction of fracture with osteotomies, right
suspension suture, opening of nasal stenosis, left, Gore-Tex graft right,
Bilateral submucous turbinoplasty with cauterization, dissection, resection,
and outfracturing. Estimated blood loss during the entire procedure was less
than 5 mL. Classic rhinoplasty dressing was applied. The patient tolerated
the procedure well and left the operating room in good condition.
After the induction of local anesthesia and prepping and draping in the usual
manner, nasal stenosis was first addressed. This was opened using a Bard 15
blade and we would proceed at the end of the procedure, inserting a Reuter
stent in the area to hold this opened for 3 weeks at least.
Intercartilaginous incisions were made bilaterally. These incisions were
extended into the nasal septal area only approximately 1-1.5 cm. Everything
was undermined over the dorsum and the lateral wall on the right side. Left
side was undermined as well. Suspension sutures were used to elevate the
upper lateral cartilage on the left side using 5-0 PDS pulling this up to the
dorsum of the nose and sutured in place at the septal angle. One suture was
used. Perforating osteotomies were done bilaterally. Nasal bones were
infractured. This gave some semblance of symmetry. There was still the
asymmetry on the right side with the caved in nasal bone even though we did
lift this out. I elected to proceed with a Gore-Tex graft. Gore-Tex was cut
to proper size, soaked in bacitracin. Bacitracin was injected into the wound
and the Gore-Tex graft was slid into place perfect fit. The incision sites
were closed using interrupted 4-0 chromics throughout the entire range. This
gave the desired result. Bilateral submucous turbinoplasty with
cauterization, dissection, resection, outfracturing was carried out without
difficulty.
So, in summary, we did open reduction of fracture with osteotomies, right
suspension suture, opening of nasal stenosis, left, Gore-Tex graft right,
Bilateral submucous turbinoplasty with cauterization, dissection, resection,
and outfracturing. Estimated blood loss during the entire procedure was less
than 5 mL. Classic rhinoplasty dressing was applied. The patient tolerated
the procedure well and left the operating room in good condition.
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