I have attached a copy of my op report. I have been unable to locate a code that comes anywhere close to what this phy. is describing. The only code that I have found indicates that a graft was used which is not the case in the op report listed below. Can anyone help point me in the right direction.


Left internal nasal valve prolapse.

POSTOPERATIVE DIAGNOSIS: Left internal nasal valve prolapse.

PROCEDURES: 1. Left lateral crural suspension suture utilizing FASTak 2.4 mm screw with 2-0 FiberWire.
2. Left simple closure of skin wound of left orbital rim.





DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position on the operating room table. General anesthesia was induced by placement of an LMA. After this was done, the patient's face was then prepped and draped in the usual standard fashion. Next, the left orbital rim was palpated. A Cottle maneuver was then performed to see the optimal vector of pull such that the left internal nasal valve would open.

Therefore, the left orbital rim was palpated in this vector and skin incision was marked with a marking pen along the infraorbital crease. After this was done, this was injected with 1% lidocaine with 1:100,000 epinephrine. After this was done, a #15-blade was used to make an incision through the skin and the subcutaneous tissue down to the subcutaneous fat. Blunt dissection with the hemostat was then performed down to the level of the left medial orbital rim. After this was done, a FASTak self drilling screw was then subsequently placed in the left medial orbital rim. Once this was secured in the orbital rim, the needles were then cut off of the 2-0 FiberWire and a straight Keith needle was then placed on the FiberWire. Next, the FiberWire was then placed through the subcutaneous tissue of the left cheek and down into the left upper lateral and lower lateral cartilages subcutaneously. This was then placed through the cartilages and into the internal nasal valve intranasally. After the suture was brought out of the nasal cavity, the Keith needle was then reloaded and the Keith needle was then placed at the scroll region of the upper lateral, lower lateral cartilages at a different spot. Then the suture had been placed previously. In fact a few millimeters just lateral to this previous exit site. It was placed through the cartilage and up through the subcutaneous tissue and out of the infraorbital wound. Next, the suture was then tightened adequately just as the internal nasal valve was widely opened. The suture was secured and tied and good results with a wide open internal nasal valve on the left were achieved. After this was done, the left infraorbital wound was then reapproximated and closed using 5-0 chromic suture and closed the skin in a simple running, locking fashion. After this was done, Bactroban cream was then placed on the patient's wound. The patient tolerated the procedure well and was transferred to the care of the anesthesia team who awoke the patient from general anesthesia in a stable condition.

The patient will be taken to the PACU for further care and treatment.