simplytam
New
I'm sorry, I am lost at sea and could use help with this op report, please. I am coming up w/ 67924, 15823 and 67904 what are your thoughts?
The entropion was addressed first and the procedure was similar on both sides. Lateral displacement (shortening) of the lower eyelid did appear to correct his ectropion so a lateral tarsal strip procedure was planned. An eye shield was placed and local was injected. The lower eyelid was displaced laterally to determine the amount of lateral tarsal plate to be exposed. This was marked and an incision was then made at the lateral orbital rim within a natural skin line. The incision was extended along the lower eyelid to the marked area and all tissue was stripped off the tarsal plate to this point. The tarsal plate was displaced laterally and secured to the periosteum on the inside of the lateral orbital rim at a level just superior to the medial canthus with permanent sutures. This did appear to correct the lower eyelid laxity as well as inward orientation of the eyelashes. The incision was then closed with absorbable sutures. The eyelashes were facing away from the globe at the end of the procedure. Attention was turned to the forehead. The patient had been marked in preop for a direct brow lift. Upper eyelid excess skin was marked using calipers. The marked skin was gently pinched together to ensure enough skin would be left so as to allow the eyelids to close and to prevent removal of too much skin. Local was injected along the planned crescentic skin excision on the forehead. The brow lift incisions were made sharply through the skin and subcutaneous fat to the underlying muscle. The muscle was not excised. Marked skin was removed full thickness. Hemostasis was achieved with cautery taking care not to cauterize too much near the eyebrow hair follicles. The incisions were then closed in layered fashion. They were not closed under tension. Attention was turned to the upper eyelids. The procedure was similar on both sides. The excess skin of the upper eyelids had been marked, and was re-checked to ensure enough skin would be left so as to allow the eyelids to close and to prevent removal of too much skin. Local anesthetic was infiltrated into the upper lids subcutaneously. The marked skin was then excised sharply followed by removal of a 2mm strip of muscle. Bleeding was controlled using electrocautery. The orbital septum was identified and opened. The levator aponeurosis was identified and found to be dehisced bilaterally as well as very thin where it was present. It was dissected free from the surrounding tissue and advanced to the tarsal plate. It was secured to the tarsal plate with interrupted sutures. The eyelid was everted to check for button-holes. The wound was closed with interrupted and running nylon suture. The procedure was repeated on the contralateral side. His eyelid did appear symmetric in height and the ptosis appeared to be resolved at the end of the procedure..
The entropion was addressed first and the procedure was similar on both sides. Lateral displacement (shortening) of the lower eyelid did appear to correct his ectropion so a lateral tarsal strip procedure was planned. An eye shield was placed and local was injected. The lower eyelid was displaced laterally to determine the amount of lateral tarsal plate to be exposed. This was marked and an incision was then made at the lateral orbital rim within a natural skin line. The incision was extended along the lower eyelid to the marked area and all tissue was stripped off the tarsal plate to this point. The tarsal plate was displaced laterally and secured to the periosteum on the inside of the lateral orbital rim at a level just superior to the medial canthus with permanent sutures. This did appear to correct the lower eyelid laxity as well as inward orientation of the eyelashes. The incision was then closed with absorbable sutures. The eyelashes were facing away from the globe at the end of the procedure. Attention was turned to the forehead. The patient had been marked in preop for a direct brow lift. Upper eyelid excess skin was marked using calipers. The marked skin was gently pinched together to ensure enough skin would be left so as to allow the eyelids to close and to prevent removal of too much skin. Local was injected along the planned crescentic skin excision on the forehead. The brow lift incisions were made sharply through the skin and subcutaneous fat to the underlying muscle. The muscle was not excised. Marked skin was removed full thickness. Hemostasis was achieved with cautery taking care not to cauterize too much near the eyebrow hair follicles. The incisions were then closed in layered fashion. They were not closed under tension. Attention was turned to the upper eyelids. The procedure was similar on both sides. The excess skin of the upper eyelids had been marked, and was re-checked to ensure enough skin would be left so as to allow the eyelids to close and to prevent removal of too much skin. Local anesthetic was infiltrated into the upper lids subcutaneously. The marked skin was then excised sharply followed by removal of a 2mm strip of muscle. Bleeding was controlled using electrocautery. The orbital septum was identified and opened. The levator aponeurosis was identified and found to be dehisced bilaterally as well as very thin where it was present. It was dissected free from the surrounding tissue and advanced to the tarsal plate. It was secured to the tarsal plate with interrupted sutures. The eyelid was everted to check for button-holes. The wound was closed with interrupted and running nylon suture. The procedure was repeated on the contralateral side. His eyelid did appear symmetric in height and the ptosis appeared to be resolved at the end of the procedure..