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Operative report:
PREOPERATIVE DIAGNOSIS: Chronic sinusitis with headache.
POSTOPERATIVE DIAGNOSIS: Chronic sinusitis with headache.
PROCEDURE PERFORMED: Bilateral endoscopic sphenoidotomy with resection of skull base, limited anterior posterior ethmoidectomy, bilateral inferior turbinate reduction, image guidance surgery.
DESCRIPTION OF PROCEDURE: After routine preop evaluation showed no contraindications to surgery or to anesthesia, the patient was brought to the Operating Room, placed in supine position on operating table. After an adequate level of general anesthesia was obtained, the patient was positioned and draped in the normal fashion for the aforementioned procedures. The patient's nasal cavity was decongested with 0.05% oxymetazoline-soaked cottonoid pledgets and the areas to be operated were infiltrated with 1% Xylocaine with 1:100,000 epinephrine. Endoscopically, a 0-degree telescope was used to examine both nasal cavities. The most direct access was to the left nasal cavity. Therefore, the left middle turbinate was lateralized and a large polyp was seen blocking the left natural ostium of the sphenoid sinus. This was biopsied with a Blakesley forceps and then using a suction microdebrider, this soft tissue was removed from the natural ostium of the sphenoid sinus. It should be noted that the image guidance system Fusion Medtronic was registered prior to the beginning of the case. Using an image-guided tracking microdebrider, the sphenoid sinus ostium was widely opened and then the bone medial to the ostium was attempted to be removed with a microdebrider. Because of the thickness of the bone, this cannot be done; therefore, multiple osteotomies had to be performed in order to widely open the posterior choanal portion of the nasal septum. This was eventually removed allowing for wide opening of the anterior face of the sphenoid sinus bilateral. The intersinus septum was then removed and all soft tissue and abnormal mucosa including some inspissated debris with what appeared to be some fungal sinusitis was removed from the left sphenoid sinus. It was copiously irrigated and then the middle turbinates were medialized after first partially resecting the left inferior turbinate, inferior aspect. The middle meatus was opened and the natural ostium including the uncinate was dilated bilateral. The inferior turbinates were then outwardly fractured. The operated areas were then packed with Surgicel and the patient was then reversed from anesthesia and extubated in the Operating Room in stable condition.
Operative report:
PREOPERATIVE DIAGNOSIS: Chronic sinusitis with headache.
POSTOPERATIVE DIAGNOSIS: Chronic sinusitis with headache.
PROCEDURE PERFORMED: Bilateral endoscopic sphenoidotomy with resection of skull base, limited anterior posterior ethmoidectomy, bilateral inferior turbinate reduction, image guidance surgery.
DESCRIPTION OF PROCEDURE: After routine preop evaluation showed no contraindications to surgery or to anesthesia, the patient was brought to the Operating Room, placed in supine position on operating table. After an adequate level of general anesthesia was obtained, the patient was positioned and draped in the normal fashion for the aforementioned procedures. The patient's nasal cavity was decongested with 0.05% oxymetazoline-soaked cottonoid pledgets and the areas to be operated were infiltrated with 1% Xylocaine with 1:100,000 epinephrine. Endoscopically, a 0-degree telescope was used to examine both nasal cavities. The most direct access was to the left nasal cavity. Therefore, the left middle turbinate was lateralized and a large polyp was seen blocking the left natural ostium of the sphenoid sinus. This was biopsied with a Blakesley forceps and then using a suction microdebrider, this soft tissue was removed from the natural ostium of the sphenoid sinus. It should be noted that the image guidance system Fusion Medtronic was registered prior to the beginning of the case. Using an image-guided tracking microdebrider, the sphenoid sinus ostium was widely opened and then the bone medial to the ostium was attempted to be removed with a microdebrider. Because of the thickness of the bone, this cannot be done; therefore, multiple osteotomies had to be performed in order to widely open the posterior choanal portion of the nasal septum. This was eventually removed allowing for wide opening of the anterior face of the sphenoid sinus bilateral. The intersinus septum was then removed and all soft tissue and abnormal mucosa including some inspissated debris with what appeared to be some fungal sinusitis was removed from the left sphenoid sinus. It was copiously irrigated and then the middle turbinates were medialized after first partially resecting the left inferior turbinate, inferior aspect. The middle meatus was opened and the natural ostium including the uncinate was dilated bilateral. The inferior turbinates were then outwardly fractured. The operated areas were then packed with Surgicel and the patient was then reversed from anesthesia and extubated in the Operating Room in stable condition.