maryir
Networker
Please - any help you can give in coding this one would be much appreciated.
]INDICATIONS FOR PROCEDURE: The patient is a 5-year-old girl who was
undergoing a dental procedure and during the nerve block portion of the
procedure, the needle was dislodged and lost in the soft tissues around the
retromolar trigone. The foreign body was confirmed by x-ray and
subsequently she was sent to an oral surgeon for operative retrieval. At
an outside institution, they were unable to achieve this, and she was
subsequently sent to the otolaryngology clinic for further treatment.
She was taken to the OR for concerns
of worsening dysphagia, nausea and vomiting.
PROCEDURE IN DETAIL: After informed consent was obtained from the
patient's parents, the patient was taken to the operating room and placed
supine on the operating room table. A 4.5 endotracheal tube was placed.
After successful induction, the patient was turned 180 degrees and prepped
and draped in standard sterile manner. A McIvor mouth retractor was used
to place the patient into suspension on the Mayo stand and a smiley mouth
retractor was used to expose the soft tissues of the right retromolar
trigone.
The prior incision was opened with Bovie electrocautery on cut, and using a
Kelly clear to auscultation and percussion, the soft tissues around the
retromolar trigone were dissected. We initially tried to verify the
position with the ultrasound. However, we were unable to identify the
needle on ultrasound. The C-arm was therefore used to verify the position
of the needle.
The needle appeared to be located medial to the ascending ramus of the
mandible imbedded in the soft tissues posterior and superior to the right
retromolar trigone. We therefore dissected in this plane, and on multiple
shots with the C-arm, we used a spinal needle to try to localize the
foreign body. However, we were unable to directly visualize the foreign
body and the C-arm was incapable of shooting in a lateral plane and was not
able to shoot through the bed. Therefore, after significant dissection
around the retromolar trigone posteriorly and posteriorly towards the
pterygoid plates, we decided to abort the procedure after several hours.
Surgicel was placed into the wound bed and the incision closed with
interrupted 3-0 Vicryl sutures.
The patient was turned back to anesthesia, extubated in the operating room
and wheeled to the recovery room in stable condition.
]INDICATIONS FOR PROCEDURE: The patient is a 5-year-old girl who was
undergoing a dental procedure and during the nerve block portion of the
procedure, the needle was dislodged and lost in the soft tissues around the
retromolar trigone. The foreign body was confirmed by x-ray and
subsequently she was sent to an oral surgeon for operative retrieval. At
an outside institution, they were unable to achieve this, and she was
subsequently sent to the otolaryngology clinic for further treatment.
She was taken to the OR for concerns
of worsening dysphagia, nausea and vomiting.
PROCEDURE IN DETAIL: After informed consent was obtained from the
patient's parents, the patient was taken to the operating room and placed
supine on the operating room table. A 4.5 endotracheal tube was placed.
After successful induction, the patient was turned 180 degrees and prepped
and draped in standard sterile manner. A McIvor mouth retractor was used
to place the patient into suspension on the Mayo stand and a smiley mouth
retractor was used to expose the soft tissues of the right retromolar
trigone.
The prior incision was opened with Bovie electrocautery on cut, and using a
Kelly clear to auscultation and percussion, the soft tissues around the
retromolar trigone were dissected. We initially tried to verify the
position with the ultrasound. However, we were unable to identify the
needle on ultrasound. The C-arm was therefore used to verify the position
of the needle.
The needle appeared to be located medial to the ascending ramus of the
mandible imbedded in the soft tissues posterior and superior to the right
retromolar trigone. We therefore dissected in this plane, and on multiple
shots with the C-arm, we used a spinal needle to try to localize the
foreign body. However, we were unable to directly visualize the foreign
body and the C-arm was incapable of shooting in a lateral plane and was not
able to shoot through the bed. Therefore, after significant dissection
around the retromolar trigone posteriorly and posteriorly towards the
pterygoid plates, we decided to abort the procedure after several hours.
Surgicel was placed into the wound bed and the incision closed with
interrupted 3-0 Vicryl sutures.
The patient was turned back to anesthesia, extubated in the operating room
and wheeled to the recovery room in stable condition.
