DATE: @TD@
PATIENT NAME: @NAME@ 


PREOPERATIVE DIAGNOSIS: 
***

POSTOPERATIVE DIAGNOSIS: 
Same

OPERATION: 
***

SURGEON: William Morrel, MD 

ANESTHESIA: General 

INDICATIONS FOR PROCEDURE:  
***

FINDINGS:  
***

DESCRIPTION OF PROCEDURE
The patient was brought to the operating room and consent and identity were verified.  General anesthesia was induced and the patient was intubated by the Anesthesia team. The bed was spun 90 degrees.  Operative time-out was performed to confirm the correct patient, procedure, and laterality.

The eyes were protected with Tegaderms.  Pledgets soaked in topical epinephrine stained with Fluorescein were inserted into each side of the nose.  The Fusion intraoperative navigation machine was loaded with the patient's images in advance and these were reviewed in detail.  Registration of the patient to the pre-operative images was completed and verified with bony landmarks.  Navigation was used periodically throughout the case.

The right nasal cavity was explored with a 0-degree endoscope. The middle turbinate was medialized with a Freer. The uncinate process was moved into a coronal plane using a Lusk probe and then removed using a back-biter and angled through-cutting instruments. The edges were cleaned with a microdebrider.  A 30-degree scope was used to visualize the right maxillary sinus ostium and this was cannulated with a Lusk probe and opened posteriorly. Biting instruments were used to remove the medial wall of the maxillary sinus down to the level of the inferior turbinate attachment.  The mucosal edges were cleaned with a microdebrider.  Care was taken to ensure that the maxillary antrostomy was connected to the natural ostium of the maxillary sinus.  Navigation was used to verify the extent of the maxillary antrostomy and integrity of the orbit.

A 0-degree scope was used to visualize the right ethmoid bulla.  A J curette was passed posterior to the ethmoid bulla and used to fracture the anterior ethmoid cells anteriorly.  These were removed with cutting instruments.  The mucosal edges were cleaned with a microdebrider.  Bony septations along the orbit were cleaned with additional cutting instruments.  Care was taken to preserve the frontal sinus outflow tract.  Navigation was used to verify the extent of the anterior ethmoidectomy and ensure that the cells along the orbit were all removed and that the dissection was carried all the way up to the skull base.

Attention was next turned to the left nasal cavity.  The left nasal cavity was explored with a 0-degree endoscope. The middle turbinate was medialized with a Freer. The uncinate process was moved into a coronal plane using a Lusk probe and then removed using a back-biter and angled through-cutting instruments. The edges were cleaned with a microdebrider.  A 30-degree scope was used to visualize the left maxillary sinus ostium and this was cannulated with a Lusk probe and opened posteriorly. Biting instruments were used to remove the medial wall of the maxillary sinus down to the level of the inferior turbinate attachment.  The mucosal edges were cleaned with a microdebrider.  Care was taken to ensure that the maxillary antrostomy was connected to the natural ostium of the maxillary sinus.  Navigation was used to verify the extent of the maxillary antrostomy and integrity of the orbit.

A 0-degree scope was used to visualize the left ethmoid bulla.  A J curette was passed posterior to the ethmoid bulla and used to fracture the anterior ethmoid cells anteriorly.  These were removed with cutting instruments.  The mucosal edges were cleaned with a microdebrider.  Bony septations along the orbit were cleaned with additional cutting instruments.  Care was taken to preserve the frontal sinus outflow tract.  Navigation was used to verify the extent of the anterior ethmoidectomy and ensure that the cells along the orbit were all removed and that the dissection was carried all the way up to the skull base.

***The head of the inferior turbinate on each side was injected with approximately 1.5 mL of 1% lidocaine with 1:100,000 epinephrine.  A stab incision was made in the head of the right inferior turbinate and the soft tissue was dissected off of the inferior turbinate bone with a caudal elevator using a 0-degree endoscope for visualization.  Submucous resection was performed with the microdebrider using a turbinate blade.  The turbinate was examined and well reduced.  The inferior turbinate was outfractured carefully with a Freer elevator.  A stab incision was then made in the head of the left inferior turbinate and the soft tissue was dissected off of the inferior turbinate bone with a caudal elevator.  Submucous resection was performed with the microdebrider using a turbinate blade.  The turbinate was examined and was well reduced.  The inferior turbinate was outfractured carefully with a Freer elevator.

The nasal cavities and sinuses were irrigated on both sides and hemostasis was assured.  A Posisep X was opened, cut in half diagonally, and trimmed to an appropriate size.  One piece was placed in the middle meatus on each side under direct visualization and then inflated using saline.  The nasal cavity was suctioned.  An orogastric tube was passed to suction the stomach.  The eyes were examined and palpated and found to be soft.  The patient was turned over to anesthesia, awakened, extubated, and taken to the recovery room with a nasal drip pad in place. 

ESTIMATED BLOOD LOSS: *** mL
 
COMPLICATIONS: None ***

SPECIMENS: ***

DISPOSITION:
The patient was transferred to the recovery room in stable condition.