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Inferior Turbinate Submucosal Reduction Operative Sample Report

DATE OF OPERATION:  MM/DD/YYYY

PREOPERATIVE DIAGNOSES:
1.  Inferior turbinate hypertrophy.
2.  Nasal obstruction.

POSTOPERATIVE DIAGNOSES:
1.  Inferior turbinate hypertrophy.
2.  Nasal obstruction.

OPERATION PERFORMED:  Bilateral inferior turbinate submucosal reduction.

SURGEON:  John Doe, MD

ASSISTANT:  Jane Doe, MD

ANESTHESIA:  General.

ESTIMATED BLOOD LOSS:  Less than 10 mL.

COMPLICATIONS:  None.

OPERATIVE FINDINGS:
1.  Severely enlarging inferior turbinates bilaterally abutting the nasal septum.
2.  Minimal response to nasal decongestion.
3.  At the conclusion of the procedure, the left nasal airway was significantly larger and the right nasal airway was somewhat more narrow but significantly improved and able to visualize posterior nasal cavity.

DESCRIPTION OF OPERATION:  The patient was brought to the operating room and placed on the table in the supine position. A suitable plane of anesthesia was obtained, and the patient was endotracheally intubated by anesthesia personnel. Next, Afrin-soaked pledgets were instilled into the nasal cavity. The pledgets were then removed. The anterior inferior turbinate was injected with 1% lidocaine with 1:100,000 epinephrine. Afrin-soaked pledgets were then reinstilled into the nasal cavity. The patient was prepped and draped in standard fashion. The Afrin-soaked pledgets were removed.

The 0-degree endoscope was used to visualize the left inferior turbinate. The Colorado-tipped Bovie was used to make a vertical incision in the anterior head of the turbinate. Bovie cautery was used to dissect down to the level of the inferior turbinate bone.

Next, the Cottle was used to free the periosteum and submucosal tissue from the bone. Once this was adequately removed from the bone, a 2.9 inferior turbinate shaver blade was inserted, and the submucosal tissue was removed, taking care not to make any rents in the mucosa. The tissue was removed anteriorly, superiorly, medially and inferiorly back the entire length of the inferior turbinate. The mucosa was also freed from the lateral aspect of the inferior turbinate bone and isolating the inferior turbinate bone. This tissue was also shaved.

Once the submucosal turbinate tissue was removed and the inferior turbinate bone was free from the mucosa, Takahashi forceps were used to grasp the bone and fracture the bone and remove it. A significant portion of the anterior-inferior turbinate bone was removed. At this point, mucosa was lateralized and large nasal airway was achieved on the left side.

The procedure was then repeated on the right side anterior-inferior turbinate. An anterior-inferior turbinate incision was made with Bovie cautery. This was carried down to the level of the bone. Submucosal tissue was removed with the shaver blade. The inferior turbinate bone was found to be far lateralized, and a plane was not able to be achieved between the inferior turbinate bone and the lateral nasal wall. Therefore, the inferior turbinate bone was not removed. Submucosal tissue was completely removed with the shaver blade.

Since there were some mucosal abrasions along the septum on the right side, a cut Doyle splint was placed and sutured to the right nasal septum with 4-0 Prolene with the knot placed in the right nasal cavity to separate the septal mucosa from the inferior turbinate mucosa. The inferior turbinate was lateralized, and the procedure was terminated. There was no significant bleeding at the conclusion of the case.