Any suggestions for the following procedure? Would 14301 be appropriate?[
FINDINGS:
1. The patient had an ill-defined mass along the previous vertical closure
in the right lower lid extending into the right mental area with deep
extension of the lesion found to be the plane of the mandibular
periosteum. The mass was resected with a 1 cm macroscopic margin
leaving a 6 x 6 full thickness defect extending to the bone involving
the periosteum. Approximately 50% of the lower lip was removed.
2. The right mental nerve was sacrificed during the resection.
3. All frozen margins were negative during the resection.
4. The lip was closed in a tension-free fashion with a Karapandzic type
closure.
5. Extensive undermining of the anterior cervical skin was performed to
allow for a cervicofacial advancement type closure of the mental
defect.
PROCEDURE IN DETAIL: The patient was seen in the preoperative suite where
the risks, benefits, and alternatives were again reviewed. Consent was
obtained. The patient was taken to the operative suite. A time-out was
performed in which the correct patient, procedure, and location were
identified. All present were in agreement. Once the appropriate plane of
general endotracheal anesthesia was obtained, the head of the bed was
rotated 180 degrees. The patient was prepped and draped in the usual
sterile fashion. The margins of the tumor were demarcated. 2:10
_________ margins lateral to the lesion were then marked and the skin was
excised with monopolar electrocautery. Dissection was carried down,
leaving a 1 cm margin and a normal cuff of tissue. Microscopically, we
2:23 _______ the underlying tumor in the oral mucosa and the lesion was
2:27 _______ down to the level of the periosteum. The periosteum was
sacrificed, and the outer cortex of the mandible was found to be grossly
normal. There was a resultant 6 x 6 cm defect, full thickness, that
required extension down to the underlying. During the course of the
resection, the - 2:48 ________ on the right was sacrificed. A
multiple-thickness defect was completed. The specimen was marked for
Pathology. It was taken to Pathology for frozen section and all margins
were negative for carcinoma. A Karapandzic-type flap was then designed
with a limb along the right and left, both of them within the peri-facial
creases. The skin was excised with monopolar electrocautery down to the
level of the dermis, which was divided using blunt dissection. The muscles
of the face and subcutaneous tissues were divided. All pertinent nerves
and areas of the face, including the facial artery, were left intact. The
intraoral mucosa was then incised. Both limbs of the Karapandzic flap were
then advanced medially. There was incomplete closure of the underlying
chin central lip defect, which required performance of cervicofacial
advancement flap from intraoral down into the neck with 4:08 _______ of
the muscle underlying and attaching to the anterior surface of the mandible
with a subplatysmal dissection down into the neck in a central and right
lateral direction 4:19 ________ advancement of all underlying remaining
chin tissue and the Karapandzic flap medially. The muscle was then closed
with multiple interrupted Vicryl sutures. All limbs of the flap were
closed with interrupted Vicryl sutures. A standing 4:34 _______ deformity
was taken off over the surface of the chin and right lateral limb of the
Karapandzic flap, in addition. The intraoral mucosa was closed with
interrupted Vicryl sutures. The skin was then closed with a running Nylon
4:48 __________. A 12-French Dobhoff tube was placed in the nose and
sutured to the nasal septum with Silk suture. Having tolerated the
procedure well, the patient was then turned over to the care of Anesthesia
and awakened without incident in satisfactory stable condition.
FINDINGS:
1. The patient had an ill-defined mass along the previous vertical closure
in the right lower lid extending into the right mental area with deep
extension of the lesion found to be the plane of the mandibular
periosteum. The mass was resected with a 1 cm macroscopic margin
leaving a 6 x 6 full thickness defect extending to the bone involving
the periosteum. Approximately 50% of the lower lip was removed.
2. The right mental nerve was sacrificed during the resection.
3. All frozen margins were negative during the resection.
4. The lip was closed in a tension-free fashion with a Karapandzic type
closure.
5. Extensive undermining of the anterior cervical skin was performed to
allow for a cervicofacial advancement type closure of the mental
defect.
PROCEDURE IN DETAIL: The patient was seen in the preoperative suite where
the risks, benefits, and alternatives were again reviewed. Consent was
obtained. The patient was taken to the operative suite. A time-out was
performed in which the correct patient, procedure, and location were
identified. All present were in agreement. Once the appropriate plane of
general endotracheal anesthesia was obtained, the head of the bed was
rotated 180 degrees. The patient was prepped and draped in the usual
sterile fashion. The margins of the tumor were demarcated. 2:10
_________ margins lateral to the lesion were then marked and the skin was
excised with monopolar electrocautery. Dissection was carried down,
leaving a 1 cm margin and a normal cuff of tissue. Microscopically, we
2:23 _______ the underlying tumor in the oral mucosa and the lesion was
2:27 _______ down to the level of the periosteum. The periosteum was
sacrificed, and the outer cortex of the mandible was found to be grossly
normal. There was a resultant 6 x 6 cm defect, full thickness, that
required extension down to the underlying. During the course of the
resection, the - 2:48 ________ on the right was sacrificed. A
multiple-thickness defect was completed. The specimen was marked for
Pathology. It was taken to Pathology for frozen section and all margins
were negative for carcinoma. A Karapandzic-type flap was then designed
with a limb along the right and left, both of them within the peri-facial
creases. The skin was excised with monopolar electrocautery down to the
level of the dermis, which was divided using blunt dissection. The muscles
of the face and subcutaneous tissues were divided. All pertinent nerves
and areas of the face, including the facial artery, were left intact. The
intraoral mucosa was then incised. Both limbs of the Karapandzic flap were
then advanced medially. There was incomplete closure of the underlying
chin central lip defect, which required performance of cervicofacial
advancement flap from intraoral down into the neck with 4:08 _______ of
the muscle underlying and attaching to the anterior surface of the mandible
with a subplatysmal dissection down into the neck in a central and right
lateral direction 4:19 ________ advancement of all underlying remaining
chin tissue and the Karapandzic flap medially. The muscle was then closed
with multiple interrupted Vicryl sutures. All limbs of the flap were
closed with interrupted Vicryl sutures. A standing 4:34 _______ deformity
was taken off over the surface of the chin and right lateral limb of the
Karapandzic flap, in addition. The intraoral mucosa was closed with
interrupted Vicryl sutures. The skin was then closed with a running Nylon
4:48 __________. A 12-French Dobhoff tube was placed in the nose and
sutured to the nasal septum with Silk suture. Having tolerated the
procedure well, the patient was then turned over to the care of Anesthesia
and awakened without incident in satisfactory stable condition.