freespririt0806
Guru
I am completely lost here I would really appreciate someone's expertise as this is not my area of coding. I thought it was 21433 but I was wrong
TIA
POSTOPERATIVE DIAGNOSIS: Multiple facial fractures to include nose, left
orbital floor, bilateral LeFort lll.
PROCEDURES: Closed nasal reduction with stabilization, open reduction and
internal fixatjon of bilateral LeFort lll with intermaxillary fixation, and
open reduction and intemal fixation of left orbital floor fracture through
multiple approaches.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite,
anesthesia induced without difficulty. The patient, procedure, and laterali$
confirmed. The face was prepped and draped. This being done, the left orbit
was evaluated 1st after local aneslhetic was injected. A subciliary incision
was made and extended laterally in the Crow's feet' A muscle skin tlap was
elevated, not perforating the orbital septum down to the orbital rim. At ttis
point, the periosleum was raised off the floor of the orbit and the fracture
as well as its margins identified' Dissection was then taken inferiorly
identifying the infra orbital nerve and dissecting around it until the facial
fractures in the maxilla were identified. Once this had been performed'
intaoral incisions were made bilaterally in the alveolar labial sulcus on
either side of the piriform aperture. These were taken immediately down to
the bone and the periosteum raised off the anterior maxilla bilaterally
identifying both medial and lateral buttress fractures. The entire mid face
appeared to be depressed and Rowe disimpaction forceps were inserted'
These were then pulled anteriorly and the face was displaced anteriorly. This
was done to the extent that I was able to get normal occlusion. Once this was
done, IMF screws were placed in the maxilla and mandible, so as not to
penetrate the apex of any viable teeth and these were wired together. Once
the patient was felt to be in good occlusion, L-plates were placed on tre
lateral butfesses bilaterally and L-plates were then placed on the medial
buttresses bilaterally. Each of them was bent, shaped accordingly, trimmed,
and 2 screws placed on either side of the fracture. The maxillary sinuses
bilaterally were inigated and washed out. Once this was performed, a piece
of the maxillary facture bone was removed because it was so comminuted. This
being done, the wound intraorally was closed in 2 layers and the surgeon's
gloves changed. At this point, attention to the left eye was performed. The
orbital plate was contoured appropriately for the defect and secured. At his
point, that wound was closed in 2 layers, suspending the orbicularis oculi
Iaterally and superiorly in he skin. Once this was performed, the nose was
evaluated. A Sayre elevator was placed intranasally and the nose fractured
into the midline. Stabilization plate was then placed over the skin of tre
nose. The IMF screws were hen removed after cutting he wires and IMF
removed intraoperatively.
TIA
POSTOPERATIVE DIAGNOSIS: Multiple facial fractures to include nose, left
orbital floor, bilateral LeFort lll.
PROCEDURES: Closed nasal reduction with stabilization, open reduction and
internal fixatjon of bilateral LeFort lll with intermaxillary fixation, and
open reduction and intemal fixation of left orbital floor fracture through
multiple approaches.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite,
anesthesia induced without difficulty. The patient, procedure, and laterali$
confirmed. The face was prepped and draped. This being done, the left orbit
was evaluated 1st after local aneslhetic was injected. A subciliary incision
was made and extended laterally in the Crow's feet' A muscle skin tlap was
elevated, not perforating the orbital septum down to the orbital rim. At ttis
point, the periosleum was raised off the floor of the orbit and the fracture
as well as its margins identified' Dissection was then taken inferiorly
identifying the infra orbital nerve and dissecting around it until the facial
fractures in the maxilla were identified. Once this had been performed'
intaoral incisions were made bilaterally in the alveolar labial sulcus on
either side of the piriform aperture. These were taken immediately down to
the bone and the periosteum raised off the anterior maxilla bilaterally
identifying both medial and lateral buttress fractures. The entire mid face
appeared to be depressed and Rowe disimpaction forceps were inserted'
These were then pulled anteriorly and the face was displaced anteriorly. This
was done to the extent that I was able to get normal occlusion. Once this was
done, IMF screws were placed in the maxilla and mandible, so as not to
penetrate the apex of any viable teeth and these were wired together. Once
the patient was felt to be in good occlusion, L-plates were placed on tre
lateral butfesses bilaterally and L-plates were then placed on the medial
buttresses bilaterally. Each of them was bent, shaped accordingly, trimmed,
and 2 screws placed on either side of the fracture. The maxillary sinuses
bilaterally were inigated and washed out. Once this was performed, a piece
of the maxillary facture bone was removed because it was so comminuted. This
being done, the wound intraorally was closed in 2 layers and the surgeon's
gloves changed. At this point, attention to the left eye was performed. The
orbital plate was contoured appropriately for the defect and secured. At his
point, that wound was closed in 2 layers, suspending the orbicularis oculi
Iaterally and superiorly in he skin. Once this was performed, the nose was
evaluated. A Sayre elevator was placed intranasally and the nose fractured
into the midline. Stabilization plate was then placed over the skin of tre
nose. The IMF screws were hen removed after cutting he wires and IMF
removed intraoperatively.
