LaceyCanon
Networker
Can someone plwase help with this procedure?
I am thinking 31295-rt, 31296-50, 31287-50, & 31254-lt, but not sure.
After informed consent was obtained, patient was taken to the operating room and placed on the operating table in supine position. After adequate general endotracheal anesthesia was induced, patient was placed in a slightly head up position and the nasal cavities were packed with Afrin-soaked pledgets bilaterally. The patient was prepped and draped in the usual sterile fashion and the operation was begun by removing the pledgets and using a zero-degree endoscope to examine the nasal cavities bilaterally. Attention was first turned to the right side. We were using the zero-degree endoscope and a Freer elevator. The middle turbinate was gently medialized and Afrin-soaked pledget was placed in the middle meatus. The similar procedure was performed on the left. The pledgets were allowed to set in place for approximately 5 minutes while the preoperative CT scans were removed. Attention was then turned back to the patient around the right side, the pledget was removed and using the balloon dilation equipment, the catheter was placed just inside the uncinate process and the wire was advanced through the maxillary ostium into the sinus. Its location was confirmed with the lighted wire and the balloon was then advanced over the wire and inflated twice to dilate the maxillary ostium. Attention was then turned to the left side where similar procedure was performed, however, the wire could not be advanced into the maxillary sinus. Attention was then turned back to the right side. We were using the appropriate frontal sinus catheter, the wire was advanced through the frontal recess into the frontal sinus and again this location was confirmed with the lighted wire. The balloon was advanced over the wire and dilated 3 times to open the frontal sinus tract. Attention was then turned back to the left side where the enlarged ethmoid bulla cell was opened with a Frazier tip suction, and then using the microdebrider fragments of bone and mucosa of the ethmoid bulla cell were removed as well as a portion of the uncinate process. This allowed visualization of the natural maxillary ostium, which was enlarged in an posterior direction using straight through-cut forceps and the edges of the bone and mucosa were removed with the microdebrider. The contents of the maxillary sinus could be inspected and the small mucocele was unroofed using a curved suction. Once the ethmoid bulla cell had been removed using the balloon catheter the wire was able to be advanced around the remnants of the ethmoid bulla cell into the left frontal sinus and its location was confirmed with the lighted wire. The balloon was advanced over the wire and inflated 3 separate times to enlarge the frontal sinus tract. An Afrin-soaked pledget was placed in the dissected field bilaterally and attention was turned to the sphenoid sinuses. The zero-degree endoscope was used to examine the posterior nasal cavity and the area of the right sphenoid opening was identified and confirmed with a straight Frazier tip suction. A Kerrison was then used to enlarge the sphenoid sinus opening working in a medial and inferior direction and then the microdebrider with the small blade was used to open the mucosa into the sphenoid sinus. The sphenoid sinus was inspected and noted to be normal. The similar procedure was then performed on the left side. First the natural sphenoid opening was identified with a straight Frazier tip suction and then enlarged using a Kerrison and the edges of the sphenoidotomy were cleaned with the microdebrider. The left sphenoid sinus was dramatically smaller than the right side. At this point, the area of the sphenoidotomy was packed with an Afrin-soaked pledget bilaterally and the patient was returned to anesthesia, awakened, and taken to recovery room in stable condition.
Any help is appreciated.
I am thinking 31295-rt, 31296-50, 31287-50, & 31254-lt, but not sure.
After informed consent was obtained, patient was taken to the operating room and placed on the operating table in supine position. After adequate general endotracheal anesthesia was induced, patient was placed in a slightly head up position and the nasal cavities were packed with Afrin-soaked pledgets bilaterally. The patient was prepped and draped in the usual sterile fashion and the operation was begun by removing the pledgets and using a zero-degree endoscope to examine the nasal cavities bilaterally. Attention was first turned to the right side. We were using the zero-degree endoscope and a Freer elevator. The middle turbinate was gently medialized and Afrin-soaked pledget was placed in the middle meatus. The similar procedure was performed on the left. The pledgets were allowed to set in place for approximately 5 minutes while the preoperative CT scans were removed. Attention was then turned back to the patient around the right side, the pledget was removed and using the balloon dilation equipment, the catheter was placed just inside the uncinate process and the wire was advanced through the maxillary ostium into the sinus. Its location was confirmed with the lighted wire and the balloon was then advanced over the wire and inflated twice to dilate the maxillary ostium. Attention was then turned to the left side where similar procedure was performed, however, the wire could not be advanced into the maxillary sinus. Attention was then turned back to the right side. We were using the appropriate frontal sinus catheter, the wire was advanced through the frontal recess into the frontal sinus and again this location was confirmed with the lighted wire. The balloon was advanced over the wire and dilated 3 times to open the frontal sinus tract. Attention was then turned back to the left side where the enlarged ethmoid bulla cell was opened with a Frazier tip suction, and then using the microdebrider fragments of bone and mucosa of the ethmoid bulla cell were removed as well as a portion of the uncinate process. This allowed visualization of the natural maxillary ostium, which was enlarged in an posterior direction using straight through-cut forceps and the edges of the bone and mucosa were removed with the microdebrider. The contents of the maxillary sinus could be inspected and the small mucocele was unroofed using a curved suction. Once the ethmoid bulla cell had been removed using the balloon catheter the wire was able to be advanced around the remnants of the ethmoid bulla cell into the left frontal sinus and its location was confirmed with the lighted wire. The balloon was advanced over the wire and inflated 3 separate times to enlarge the frontal sinus tract. An Afrin-soaked pledget was placed in the dissected field bilaterally and attention was turned to the sphenoid sinuses. The zero-degree endoscope was used to examine the posterior nasal cavity and the area of the right sphenoid opening was identified and confirmed with a straight Frazier tip suction. A Kerrison was then used to enlarge the sphenoid sinus opening working in a medial and inferior direction and then the microdebrider with the small blade was used to open the mucosa into the sphenoid sinus. The sphenoid sinus was inspected and noted to be normal. The similar procedure was then performed on the left side. First the natural sphenoid opening was identified with a straight Frazier tip suction and then enlarged using a Kerrison and the edges of the sphenoidotomy were cleaned with the microdebrider. The left sphenoid sinus was dramatically smaller than the right side. At this point, the area of the sphenoidotomy was packed with an Afrin-soaked pledget bilaterally and the patient was returned to anesthesia, awakened, and taken to recovery room in stable condition.
Any help is appreciated.