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Repair of Facial and Internal Nasal Lacerations, Open Reduction of Nasal Septal Fracture Operative Example

DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed in supine position. IV general anesthetic was induced. An oral endotracheal tube was then passed without difficulty. The patient was then prepped and draped in routine sterile fashion. Lacri-Lube was placed in the eyes bilaterally. Local anesthesia was induced by the infiltration of 1% Xylocaine with 1:100,000 epinephrine to the appropriate areas. After this was taken back, surgery was begun. The facial lacerations on the nasal dorsum were approximately 1.5 cm in length, which was repaired with 6-0 Prolene. He also had multiple smaller lacerations in the left upper eyelid which were again repaired with 6-0 Prolene. The patient had a 1 cm laceration of the mucosa of the upper lip on the right side, which was also repaired with 5-0 chromic. At this point in time, attention was directed to the internal nasal injuries themselves. Old clots were re-evacuated from this area and the site was irrigated. The patient was noted to have several internal nasal lacerations and an open nasal septal fracture. The site was debrided of old clots and the internal nasal lacerations were closed with 5-0 chromic. The patient also had a septal hematoma which was evacuated and mucosa was sutured through-and-through utilizing a straight Keith and 4-0 chromic suture. This was done in a continuous horizontal mattress fashion working away around the entire nasal septum. Once this was completed, the Sayer elevator was placed internally into each naris and the nasal bones were elevated superiorly and reduced to the appropriate position. A 0.25 inch Nu Gauze which was impregnated with antibiotic ointment was then packed lightly into the superior aspects of the nasal bones to provide internal nasal support. Once this was completed, the Denver splint was adapted to the nasal dorsum and the metal reinforcement splint was compressed so as to give proper support externally to the nasal bones. During the procedure, the patient received 1250 mL of crystalloid solution as well as 1 gram of Ancef and 8 mg of Decadron. Estimated blood loss was less than 100 mL. There were no complications during the procedure and no drains were placed. There are no specimens removed.

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