daknaack
Networker
I am having a real challenge trying to code this op. Any help/suggestions would be greatly appreciated....
OPERATIVE PROCEDURE PERFORMED:
Wide local excision of floor of mouth carcinoma with partial excision of the left
sublingual gland and rerouting of the left submandibular duct.
Patient was taken to the operating room and after induction of general anesthesia, the lesion
on the floor of mouth was examined. Lesion was about 1 cm posterior to the opening for
the submandibular duct and it was right along the ridge of the sublingual gland. I was
able to cannulate the submandibular duct with a lacrimal probe and dilated the duct up to
a number 2 lacrimal probe. I then marked an incision about the lesion in the floor of
mouth providing for about 1 cm of normal appearing tissue about the entire lesion. Once
this was completed I then infiltrated the floor of mouth with 1% lidocaine with
epinephrine. I made the incision around this lesion and anteriorly in the region of
the submandibular duct I had to make the apex of the incision just beyond the
submandibular duct opening and therefore I then dissected the submandibular duct from the
attachment to the mucosa on the floor of the mouth and then retracted that duct
posteriorly away from the sublingual gland and the tissue which was to be excised. As I
completed the fusiform incision along the anterior and posterior margins of the lesion.
They then met about 1 cm to 1.5 cm posterior to the posterior aspect of the lesion and
then I developed a deep margin along the sublingual gland and a portion of the sublingual
gland was excised together with the abnormal mucosa to provide for an adequate deep
margin around this lesion.
Once the lesion was removed completely, it was then sent for frozen inspection analysis.
There was squamous cell carcinoma noted within the specimen but all margins including the
deep margin were clear of any cancer. There was some microscopic invasion noted on the
biopsy. I therefore elected to close the floor of the mouth primarily. First of all I
made an incision along the length of the submandibular duct for the distance of about 8
to 10 mm. This allowed me to then marsupialize the duct and reroute it in a location
just posterior to where it had originally exited into the floor of mouth. I closed the
floor of mouth posterior to this area with 4-0 Chromic suture and then as I came up to
the location where I planned to reroute the duct I began to suture the duct to the
surrounding mucosa. This allowed for marsupialization of the duct in this area. I then
closed the mucosa anterior to where the duct had been rerouted to and was satisfied with
the closure at this point.
Once the closure had been completed the patient was awakened from anesthesia, extubated
and taken to the recovery room in stable condition.
OPERATIVE PROCEDURE PERFORMED:
Wide local excision of floor of mouth carcinoma with partial excision of the left
sublingual gland and rerouting of the left submandibular duct.
Patient was taken to the operating room and after induction of general anesthesia, the lesion
on the floor of mouth was examined. Lesion was about 1 cm posterior to the opening for
the submandibular duct and it was right along the ridge of the sublingual gland. I was
able to cannulate the submandibular duct with a lacrimal probe and dilated the duct up to
a number 2 lacrimal probe. I then marked an incision about the lesion in the floor of
mouth providing for about 1 cm of normal appearing tissue about the entire lesion. Once
this was completed I then infiltrated the floor of mouth with 1% lidocaine with
epinephrine. I made the incision around this lesion and anteriorly in the region of
the submandibular duct I had to make the apex of the incision just beyond the
submandibular duct opening and therefore I then dissected the submandibular duct from the
attachment to the mucosa on the floor of the mouth and then retracted that duct
posteriorly away from the sublingual gland and the tissue which was to be excised. As I
completed the fusiform incision along the anterior and posterior margins of the lesion.
They then met about 1 cm to 1.5 cm posterior to the posterior aspect of the lesion and
then I developed a deep margin along the sublingual gland and a portion of the sublingual
gland was excised together with the abnormal mucosa to provide for an adequate deep
margin around this lesion.
Once the lesion was removed completely, it was then sent for frozen inspection analysis.
There was squamous cell carcinoma noted within the specimen but all margins including the
deep margin were clear of any cancer. There was some microscopic invasion noted on the
biopsy. I therefore elected to close the floor of the mouth primarily. First of all I
made an incision along the length of the submandibular duct for the distance of about 8
to 10 mm. This allowed me to then marsupialize the duct and reroute it in a location
just posterior to where it had originally exited into the floor of mouth. I closed the
floor of mouth posterior to this area with 4-0 Chromic suture and then as I came up to
the location where I planned to reroute the duct I began to suture the duct to the
surrounding mucosa. This allowed for marsupialization of the duct in this area. I then
closed the mucosa anterior to where the duct had been rerouted to and was satisfied with
the closure at this point.
Once the closure had been completed the patient was awakened from anesthesia, extubated
and taken to the recovery room in stable condition.