bmanus
Guru
Good morning,
I could use some help with this report.
Lateral rhinotomy incision was made on the left side from the base of the lobe along the lateral nasal skin with a V cut to the medial canthus and into the lower brow. Tissue was deepened down to the nasal bone and along the piriform aperture. Tumor mass which was at the inferior portion of the medial canthus along the inferior orbital rim. The maxilla was found lateral to this and was elevated a short distance until the infraorbital foramen was identified with the nerve intact. The maxilla was exposed down to the lower portion. The superior portion of the medial canthal region was then elevated until the anterior ethmoid artery was identified. This was clipped ?3 and bipolared and separated. The posterior ethmoid artery was separated with a bipolar only.
The osteotomes were used to enter the maxillary sinus rhythm the anterior wall. The fractured bone was removed and the sinus was inspected. There was mucosal edema but no tumor noted. The sagittal saw was then used to cut through the bone of the piriform aperture underneath the inferior turbinate. A second cut was made through the infraorbital rim lateral to the tumor. Next cut was along the nasal bone just off of midline in the final cut was through the nasal bone to the ethmoids superior, just inferior to the line of the ethmoid arteries. The vault elevator was used to fracture the rest of the orbital floor on the medial side as well as the ethmoid complex in the posterior maxillary wall. Scissors were then used to cut through the inferior turbinate and the mucosa of the posterior lateral nasal wall. Hemostasis was achieved with the Bovie in the tumor was removed. During the intranasal cuts the tumor was found to be adhesed to the septum. Frozen sections were then taken circumferentially and the septum was questionable so a second layer was taken down to own and cartilage and a 1-1/2 cm?.
The sphenoid sinus was then opened through the medial maxillectomy incision and was taken down with rongeurs. The mucosa was removed around the inferior rim. The frontal sinus was then identified and was opened with a curet and soft tissue was taken down and was sent as a frozen section came back as negative as well.
The patient had a lacrimal stents previously placed and this was still left into position.
A craniofacial mesh plate was then brought in and was placed from the lower frontal bone along the nasal bone and then down to reconstitute the anterior medial orbital wall and was attached to the inferior orbital rim. Attached segments and the upper anterior maxillary wall. This was secured with five and 6 mm screws.
Copious irrigation then occurred and the nose was packed with a 8 cm Merocel packing after surgi flo was placed.
The medial canthus was attached to the plate medially and posteriorly to re-create the pole of the medial canthal tendon. This was done with a 3-0 Prolene. The skin was then closed with interrupted 3?0 Vicryls in a running 5-0 Prolene.
Thank you
I could use some help with this report.
Lateral rhinotomy incision was made on the left side from the base of the lobe along the lateral nasal skin with a V cut to the medial canthus and into the lower brow. Tissue was deepened down to the nasal bone and along the piriform aperture. Tumor mass which was at the inferior portion of the medial canthus along the inferior orbital rim. The maxilla was found lateral to this and was elevated a short distance until the infraorbital foramen was identified with the nerve intact. The maxilla was exposed down to the lower portion. The superior portion of the medial canthal region was then elevated until the anterior ethmoid artery was identified. This was clipped ?3 and bipolared and separated. The posterior ethmoid artery was separated with a bipolar only.
The osteotomes were used to enter the maxillary sinus rhythm the anterior wall. The fractured bone was removed and the sinus was inspected. There was mucosal edema but no tumor noted. The sagittal saw was then used to cut through the bone of the piriform aperture underneath the inferior turbinate. A second cut was made through the infraorbital rim lateral to the tumor. Next cut was along the nasal bone just off of midline in the final cut was through the nasal bone to the ethmoids superior, just inferior to the line of the ethmoid arteries. The vault elevator was used to fracture the rest of the orbital floor on the medial side as well as the ethmoid complex in the posterior maxillary wall. Scissors were then used to cut through the inferior turbinate and the mucosa of the posterior lateral nasal wall. Hemostasis was achieved with the Bovie in the tumor was removed. During the intranasal cuts the tumor was found to be adhesed to the septum. Frozen sections were then taken circumferentially and the septum was questionable so a second layer was taken down to own and cartilage and a 1-1/2 cm?.
The sphenoid sinus was then opened through the medial maxillectomy incision and was taken down with rongeurs. The mucosa was removed around the inferior rim. The frontal sinus was then identified and was opened with a curet and soft tissue was taken down and was sent as a frozen section came back as negative as well.
The patient had a lacrimal stents previously placed and this was still left into position.
A craniofacial mesh plate was then brought in and was placed from the lower frontal bone along the nasal bone and then down to reconstitute the anterior medial orbital wall and was attached to the inferior orbital rim. Attached segments and the upper anterior maxillary wall. This was secured with five and 6 mm screws.
Copious irrigation then occurred and the nose was packed with a 8 cm Merocel packing after surgi flo was placed.
The medial canthus was attached to the plate medially and posteriorly to re-create the pole of the medial canthal tendon. This was done with a 3-0 Prolene. The skin was then closed with interrupted 3?0 Vicryls in a running 5-0 Prolene.
Thank you