AgnieszkaLakritz
Networker
1. Bilateral tonsillar hypertrophy.
2. Chronic tonsillitis.
3. Bilateral inferior turbinate hypertrophy.
PROCEDURES:
1. Coblation tonsillectomy.
2. Bilateral powered submucous resection of inferior turbinates with therapeutic outfracture.
ANESTHESIA TYPE:
General endotracheal anesthesia.
ESTIMATED BLOOD LOSS:
Less than 20 mL.
INTRAOPERATIVE FINDINGS:
There is 3+ tonsillar hypertrophy, 2 to 3+ adenoid hypertrophy, no significant adenoid tissue.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was taken to the operating room and placed on the operating room table in the supine position. General endotracheal anesthesia was obtained. The operating room table was rotated 90 degrees in a clockwise direction. A head drape was applied. The patient was draped in the standard fashion. The procedure was begun by performing anterior rhinoscopy.
Each inferior turbinate was injected using about 2 mL of 1% lidocaine with epinephrine to distend the soft tissues. Following this, a Straightshot microdebrider with a 2 mm inferior turbinate blade was used to create a stab incision on the anterior aspect of the left turbinate creating a submucosal pocket along the medial aspect of the conchal bone. The blade was then rotated medially and the Straightshot was used to take down the submucosal soft tissue proceeding in a sweeping fashion, posteriorly to anteriorly. The inferior aspect of each conchal bone was addressed using the microdebrider as well. The left turbinate was then outfractured using a Boies elevator. An identical procedure was performed on the right.
After completing bilateral turbinate submucous resection, the nasal cavities were suctioned. Two Afrin-saturated cottonoid pledgetswere placed against the turbinate in each nasal cavity. Next, a Crow-Davis gag retractor was gently introduced into the oral cavity, placing this to tension and suspending it from the Mayo stand. A red rubber catheter was passed through the right naris, pulled through the oral cavity, and used to retract the soft palate. The nasopharynx was inspected using laryngeal mirror. There was no significant adenoid tissue. The tonsils were as noted above. The right tonsil was addressed first, grasping this with a curved Allis clamp, and retracting it medially. An ArthroCare EVac 70 Xtra Coblation wand was used to dissect along the anterior tonsillar pillar, down to the plane of the tonsillar capsule. Dissection was carried out in this pericapsular plane, proceeding superiorly to inferiorly, and anteriorly to posteriorly, freeing it at the inferior pole. The left tonsil was removed in an identical fashion. Limited Coblation cautery was performed at both superior and inferior poles.
Hemostasis was excellent. The oropharynx was irrigated. The stomach was suctioned using an orogastric tube. The gag retractor was released from tension and suspension for a minute or 2, and then placed back to tension. Hemostasis remained excellent. The gag retractor and red rubber catheter were removed. The cottonoid pledgets were removed from the nasal cavities. The nasal cavities were suctioned. A rolled piece of Telfa coated in Bactroban was placed in each nasal cavity as a temporary pack. At this point, the procedure was complete, and the patient returned to the care of Dr. Snow. She was awakened, extubated, and taken to the recovery room with plans for prolonged OSA protocol observation.
2. Chronic tonsillitis.
3. Bilateral inferior turbinate hypertrophy.
PROCEDURES:
1. Coblation tonsillectomy.
2. Bilateral powered submucous resection of inferior turbinates with therapeutic outfracture.
ANESTHESIA TYPE:
General endotracheal anesthesia.
ESTIMATED BLOOD LOSS:
Less than 20 mL.
INTRAOPERATIVE FINDINGS:
There is 3+ tonsillar hypertrophy, 2 to 3+ adenoid hypertrophy, no significant adenoid tissue.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was taken to the operating room and placed on the operating room table in the supine position. General endotracheal anesthesia was obtained. The operating room table was rotated 90 degrees in a clockwise direction. A head drape was applied. The patient was draped in the standard fashion. The procedure was begun by performing anterior rhinoscopy.
Each inferior turbinate was injected using about 2 mL of 1% lidocaine with epinephrine to distend the soft tissues. Following this, a Straightshot microdebrider with a 2 mm inferior turbinate blade was used to create a stab incision on the anterior aspect of the left turbinate creating a submucosal pocket along the medial aspect of the conchal bone. The blade was then rotated medially and the Straightshot was used to take down the submucosal soft tissue proceeding in a sweeping fashion, posteriorly to anteriorly. The inferior aspect of each conchal bone was addressed using the microdebrider as well. The left turbinate was then outfractured using a Boies elevator. An identical procedure was performed on the right.
After completing bilateral turbinate submucous resection, the nasal cavities were suctioned. Two Afrin-saturated cottonoid pledgetswere placed against the turbinate in each nasal cavity. Next, a Crow-Davis gag retractor was gently introduced into the oral cavity, placing this to tension and suspending it from the Mayo stand. A red rubber catheter was passed through the right naris, pulled through the oral cavity, and used to retract the soft palate. The nasopharynx was inspected using laryngeal mirror. There was no significant adenoid tissue. The tonsils were as noted above. The right tonsil was addressed first, grasping this with a curved Allis clamp, and retracting it medially. An ArthroCare EVac 70 Xtra Coblation wand was used to dissect along the anterior tonsillar pillar, down to the plane of the tonsillar capsule. Dissection was carried out in this pericapsular plane, proceeding superiorly to inferiorly, and anteriorly to posteriorly, freeing it at the inferior pole. The left tonsil was removed in an identical fashion. Limited Coblation cautery was performed at both superior and inferior poles.
Hemostasis was excellent. The oropharynx was irrigated. The stomach was suctioned using an orogastric tube. The gag retractor was released from tension and suspension for a minute or 2, and then placed back to tension. Hemostasis remained excellent. The gag retractor and red rubber catheter were removed. The cottonoid pledgets were removed from the nasal cavities. The nasal cavities were suctioned. A rolled piece of Telfa coated in Bactroban was placed in each nasal cavity as a temporary pack. At this point, the procedure was complete, and the patient returned to the care of Dr. Snow. She was awakened, extubated, and taken to the recovery room with plans for prolonged OSA protocol observation.