Transcanal injections were then performed, as well as a postauricular sulcus injection for possible graft harvest. Her ear was then prepped and draped in sterile fashion with Betadine solution. Using the operative microscope, a tympanomeatal flap was then raised using a curved Beaver blade, subsequently followed by a weapon elevator. The middle ear mucosa was incised with a Rosen needle and then the annulus elevator was then used to elevate the rest of the tympanomeatal flap. There was some cartilage that was impregnated into the eardrum. Underneath this was a titanium head that was incorporated into the cartilage. Sitting on top of the capitulum of the stapes was a shaft, however, the titanium head was separate from the shaft, with no communication or articulation. Therefore, the titanium head was removed. The shaft was removed from the capitulum. The middle ear mucosa and space was evaluated. It was healthy. The stapes capitulum was palpated gently and felt to be intact, with an intact superstructure. Manubrium of the malleus was palpated with mobility noted as well. Therefore, a Dornhoffer middle ear PORP with adjustable links was chosen for reconstruction. Sizes were used to identify the appropriate length, which was 2.5 mm. It was then cut to the appropriate size.

A postauricular incision was then performed for harvesting a fascial graft. A small fascial graft was harvested, overriding the temporalis muscle. This was mainly a scar and fatty tissue and loose areolar tissue, as the temporalis fascia was not present. This was placed on a press and then dried on a back table.

The fascial graft was then laid in an underlay technique re-enforcing the posterior aspect of the eardrum that had been previously elevated and advanced to the level of the manubrium of the malleus. The Dornhoffer implant was then placed in the lateral canal, positioned on top of the capitulum of the stapes, and then gently swung its hydroxyapatite head until it was in good approximation with the manubrium of the malleus with the knots positioned nicely on the manubrium. The posterior middle ear space was then filled with some Gelfoam to help support the graft. The graft was then brought back into its normal position on top of the medial canal, and then two small further pieces of Gelfoam were applied to the incision site, followed by subsequent placement of antibiotic ointment.

The postauricular incision was then closed

Doc wants 69642 and I see 69637?!!

Could someone take a look..