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Old 06-17-2011, 11:59 AM
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CVelez CVelez is offline
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Default Help with oral cavity excision with neck dissection.

Any suggestions would be appreciated. I am not sure if there is one code to cover oral cavity excision and neck dissection. Thanks in advance.



Operation Performed: Wide local excision of a large oral cavity cancer, right neck dissection involving lymph nodes in level 1, 2 and 5 and split thickness skin graft from right thigh, approximately 8 x 4 cm.

Findings at the time of surgery:

Approximately a 4 cm ulcerated lesin involving the right lateral tongue, floor of mouth, extending to the base of tongue, anterior tonsillar pillar and carcinoma in-situ changes on the floor of the mouth that approach midline. The frozen section margins were negative for tumor and the tumor was sent in its entirety for permanent section. There was approximately a 2 cm level 2 lymph node that was removed. A 1 cm level 5 lymph node that was removed, small small lymph nodes from level 1 in teh submandibular gland. All nerves and blood vessels were identified and preserved in the neck. The lingual nerve and XII cranial nerves were identified and preserved as well as lingual artery.

Description of procedure:

The patient was taken to the operating room and placed in supine position. After general endotracheal anesthesia was induced, the oral cavity are as examined and the lesion was excised using several mm margings. Dissection was carried out in all plances with identification of the nerves and blood vessels for preservation. The frozen section margins were then taken and sent and came back negative.

The oral cavity area was covered and the right neck and right thigh were prepped and draped in sterile fashion. A curvilinear incision was made in the right upper neck. Subplastysmal flaps were elevated. Submandibular gland was identified dissectoin was carried out around it. Facial artery and marginal mandibular nervew were preserved. The level 1 dissection was performed as wall as a large lymph node from level 2 and a smaller lymph node inferior to that, and a level 5 lymph node removed. The wound was irrigated. A #7 Jackson-Pratt drain was placed and it was closed in 3 layers.

Split thickness skin graft was harvested from the right thigh and sutured in position with a bolster in the floor or mouth region.
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