sksmith31
Contributor
Can someone tell me if this is 69631 & 21235?
INDICATIONS:
The patient is an 83-year-old gentleman with a persistent left central tympanic membrane perforation from a previous PE tube site. Attempt at previous fat graft myringoplasty was unsuccessful and the patient presented for repair of the tympanic membrane perforation with a butterfly graft tympanoplasties.
FINDINGS:
Intraoperative findings revealed a small central perforation measuring just under 2 mm. No other abnormality was noted.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was taken to the operative room, placed on the operating table in supine position. After adequate general endotracheal anesthesia was induced, the patient's head was gently turned to the right. The area of tragal cartilage was injected with approximately 0.5 mL of 1% lidocaine with 1:100,000 epinephrine. The patient was prepped and draped in usual sterile fashion. The operation was begun by using the microscope to clean the contents of the left ear canal with a combination of the suction and curette. The largest ear speculum the canal would accommodate was placed in the ear and the tympanic membrane was fully visualized under microscopic magnification. Using a Rosen needle, the anterior circumference of the perforation was freshened and then the microscope was withdrawn. Using a 15 blade scalpel, an incision was made on the lower medial aspect of the tragal cartilage just proximal to the tip. This was then carried down to the perichondrium on both the anterior and posterior aspect of the tragal cartilage using Metzenbaum scissors. A 2 mm punch was then used to obtain a disk of cartilage for the graft. This was placed on the back table. The tragal wound was then thoroughly irrigated and suctioned and then closed using simple interrupted 4-0 chromic suture. Attention was then turned to the graft where using pickups and a Beaver blade, the outer edge of the circumference of the cartilage graft was incised creating a butterfly graft. The ear speculum was placed back in the left ear and the microscope brought back into the field. Under microscopic visualization, the graft was advanced into the ear canal and placed on the eardrum and then inserted through the perforation so that the inner rim of the cartilage graft was on the medial side of the tympanic membrane and the outer edge was on the lateral side of the tympanic membrane. Several pieces of Gelfoam were placed over the graft and the lateral ear canal was filled with antibiotic ointment. The patient was returned to Anesthesia, awakened, and taken to recovery room in stable condition.
ESTIMATED BLOOD LOSS:
INDICATIONS:
The patient is an 83-year-old gentleman with a persistent left central tympanic membrane perforation from a previous PE tube site. Attempt at previous fat graft myringoplasty was unsuccessful and the patient presented for repair of the tympanic membrane perforation with a butterfly graft tympanoplasties.
FINDINGS:
Intraoperative findings revealed a small central perforation measuring just under 2 mm. No other abnormality was noted.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was taken to the operative room, placed on the operating table in supine position. After adequate general endotracheal anesthesia was induced, the patient's head was gently turned to the right. The area of tragal cartilage was injected with approximately 0.5 mL of 1% lidocaine with 1:100,000 epinephrine. The patient was prepped and draped in usual sterile fashion. The operation was begun by using the microscope to clean the contents of the left ear canal with a combination of the suction and curette. The largest ear speculum the canal would accommodate was placed in the ear and the tympanic membrane was fully visualized under microscopic magnification. Using a Rosen needle, the anterior circumference of the perforation was freshened and then the microscope was withdrawn. Using a 15 blade scalpel, an incision was made on the lower medial aspect of the tragal cartilage just proximal to the tip. This was then carried down to the perichondrium on both the anterior and posterior aspect of the tragal cartilage using Metzenbaum scissors. A 2 mm punch was then used to obtain a disk of cartilage for the graft. This was placed on the back table. The tragal wound was then thoroughly irrigated and suctioned and then closed using simple interrupted 4-0 chromic suture. Attention was then turned to the graft where using pickups and a Beaver blade, the outer edge of the circumference of the cartilage graft was incised creating a butterfly graft. The ear speculum was placed back in the left ear and the microscope brought back into the field. Under microscopic visualization, the graft was advanced into the ear canal and placed on the eardrum and then inserted through the perforation so that the inner rim of the cartilage graft was on the medial side of the tympanic membrane and the outer edge was on the lateral side of the tympanic membrane. Several pieces of Gelfoam were placed over the graft and the lateral ear canal was filled with antibiotic ointment. The patient was returned to Anesthesia, awakened, and taken to recovery room in stable condition.
ESTIMATED BLOOD LOSS: