Surgeon(s): ***
Assistant Surgeon(s): ***
Preoperative Diagnosis: ***
Postoperative Diagnosis: Same
Procedure(s): ***
Anesthesia: General
Implants: None
Specimen:***
Drains: None
Fluids: See anesthesia record
EBL: Minimal
Complications: None
Counts: Correct x2
Indications: ***
Findings: As expected
Procedure in Detail:
The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail. The patient was transferred to the operating room by the anesthesia team. The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures. A time-out was performed and the procedure began.
A forced auction test was performed with tissue forceps on the affected side noting full range of motion of the orbit. A corneal shield with lacrilube was placed over the globe. A marking pen was used to mark the site of the lateral brow incision. 10 ml of 2% lidocaine w 1:100k epinephrine was injected at the site of the lateral brow , transconjunctival, and vestibular incisions.
First attention was directed at the transconjunctival incision. A daymar retractor was used to retract the lower lid and provide tension while a malleable was used to retract the orbit. A bovie set at 15/15 W was used to make the initial incision through the conjunctiva. The bovie tip was then used to sound to bone and the movie was used to deepen the incision to the infraorbital rim. A #9 subperiosteal elevator and blunt dissection was used to expose the infraorbital rim and the fracture. The fracture was gently curettage and derided.
Next attention was directed to the lateral brow incision. A 15 blade was used to make an incision through skin and subcutaneous tissue. Next blunt dissection was used to go down to bone and the fracture site was exposed.
Next attention was directed intramurally. An incision was made in the maxillary vestibule with a bovie staying 5 mm away from the mucogingival junction. A #9 subperiosteal elevator and blunt dissection were used to bluntly dissect to to the site of the fracture being conscious not to damage the infraorbital nerve.
Attention was then directed to the fracture site at the frontozygomatic suture. A 4 hole mid face plate was placed at the site of the fracture and the plate was stabilized on the stable skull base side. A 15 blade was used to make a nick incision at the molar prominence and a Caroll-Girard screw was placed in stable bone a the zygoma and manipulated to an ideal reduction. The plate over the frontozygomatic suture was then fixated with mono cortical fixation.
Next attentio was directed at the inferior orbital rim where a good reduction was noted. A mid face plate and mono cortical screws were used to fixate the fracture site. Next attention was directed intramurally and a long spanning mid face plate was used to span the fracture and was fixated using mono cortical screws under copious irrigation.
The corneal shield was removed and a forced duction test was performed showing full range of motion of the globe. Closure of the skin incisions was completed in a layered fashion using 4-0 vicryl and 5-0. The corneal shield as replaced and the conjunctival incision was closed with 5-0 chromic gut single interrupted sutures. The vestibular incision was closed with 3-0 chromic gut in a running fashion. The globe was irrigated with ophthalmic solution.
The patient's face was then cleaned and the posterior pharynx was suctioned. Bacitracin was placed over the skin incisions. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.
