Surgical Procedure Card – Student Case Study # 9 Efren Gonzalez date 4/18/12 Procedure name and purpose/ definition: Septoplasty / bilateral tonsillectomy. ;is a corrective surgical procedure done to straighten the nasal septum. ; surgical procedure in which the tonsils are removed from either side of the throat. What is the prognosis of the procedure? to give a good breathing passage. and to stop inflammation of the tonsils Patient level : adult
Gender : female Additional pertinent patient/ procedure information: n/a Probable preoperative diagnosis ; Nasal septal deviation ; Tonsillitis Diagnostic intervention ; diviated nasal septal. Discuss the relevant anatomy and physiology;septum – made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose. The nose is the major portal of air exchange between the internal and external environment.
The nose participates in the vital functions of conditioning inspired air toward a temperature of 37°C and 100% relative humidity, providing local defense and filtering inhaled particulate matter and gases. It also functions in olfaction, which provides both a defense and pleasure for the individual Pathophysiology (disease process). disrupted sleep patterns, headaches List the equipment that will be needed for this procedure: forced air warming device , valley lab bovie, sitting stool, fiber optic headlight,
List the instrument pans/sets used: nasal procedures tray, microdrill, endoscopic. list the supplies that will be needed for the procedure. pack =sinus pack blades=#15, drains= penrose 1/4 x 18 (but did not see it on the field used) suture= 3-0 nylon suture, 4-0 vicryl basin set= single drapes=, 1/2 sheet , adhesive strip across the forehead. U drape dressings= 4×4, pharmaceuticals = NS for irrigation 1000cc, lidocaine 0. 5%, epinephrine 1%, lidocaine with epinephrine 1:1 miscellaneous= pens Anesthesia ; General
List patient’s position and items used for positioning ; supine with pillow under knees. arm resting to her sides. Where razors and clippers used preoperatively : no List the prep solution and perimeters of the skin prep. : Duraprep the eternal nose and face, extend the prep from the hairline to the shoulders and down to the table at the sides of the neck. list the order in which drapes will be placed: towel, 1/2 sheet , U drape incision : hemitransfixion incision, counts when performed ? before surgery, and after specimens: tonsill , and septum
Postoperative patient care considerations; pain medication , no lifting , no running potential complications ; bleeding , infection , difficult breathing wound classification; clean contaminated class 2 24. The patient was placed on the operating room table in the supine position. After adequate general endotracheal anesthesia was administered, the right and left nasal septal mucosa and right and left inferior turbinates were anesthetized with 1% lidocaine with 1:100,000 epinephrine using approximately 10 mL. Afrin-soaked pledgets were placed in the nasal cavity bilaterally.
The face was prepped with pHisoHex and draped in a sterile fashion. A hemitransfixion incision was performed on the left with a #15 blade and submucoperichondrial and mucoperiosteal flap was raised with the Cottle elevator. Anterior to the septal deflection, the septal cartilage was incised and an opposite-sided submucoperichondrial and mucoperiosteal flap was raised with the Cottle elevator. The deviated portion of the nasal septal cartilage and bone was removed with a Takahashi forceps, and a large inferior septal spur was removed with a V-chisel.
Once the septum was reduced in the midline, the hemitransfixion incision was closed with a 4-0 Vicryl in an interrupted fashion ( note, using a heaney needle holder with tissue with teeth, and suture finished off with a metzenbuam scissor). The right and left inferior turbinates were trimmed in a submucous fashion using straight and curved turbinate scissors under direct visualization with a 4 mm 0 degree Storz endoscope. Hemostasis was acquired by using suction electrocautery.
The turbinates were then covered with bacitracin ointment after cauterizing them and bacitracin ointment soaked Doyle splints were placed in the right and left nares and secured anteriorly to the columella with a 3-0 nylon suture ( note, using a heaney needle holder with tissue with teeth, and suture finished off with a metzenbuam scissor). A butter knife was inserted and turned 360 in the nose to check if the patient has enough space to allow for breathing. The table was then turned. A shoulder roll placed under the shoulders and the face was draped in a clean fashion.
A McIvor mouth gag was applied. The tongue was retracted and the McIvor was gently suspended from the Mayo stand. The left tonsil was grasped with a curved Allis forceps, retracted medially, and the anterior tonsillar pillar was incised with Bovie electrocautery. The tonsil was removed from the superior pole to inferior pole using a Bovie electrocautery in its entirety in a subcapsular fashion. The right tonsil was grasped with a curved allis, in a similar fashion, retracted medially, and the anterior tonsillar pillar was incised with Bovie electrocautery.
The tonsil was removed from the superior pole to inferior pole using Bovie electrocautery in its entirety in a subcapsular fashion. The inferior, middle, and superior pole vessels were further cauterized with suction electrocautery. The extremely edematous portion of soft palate was resected using a right angle clamp and right angle scissor and was closed with 3-0 Vicryl in a figure-of-eight interrupted fashion , ( note, using a heaney needle holder with tissue with teeth, and suture finished off with a metzenbuam scissor).
Copious saline irrigation of the oral cavity was then performed. There was no further identifiable bleeding at the termination of the procedure. The estimated blood loss was less than 10 mL. The patient was extubated in the operating room, brought to the recovery room in satisfactory condition. There were no intraoperative complications. http://www. youtube. com/watch? v=kUOAhZOkgEg http://www. youtube. com/watch? v=1gnxNgP8xO4