DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Obstructive sleep apnea.
2. Dental caries, tooth #4, nonrestorable.
POSTOPERATIVE DIAGNOSES:
1. Obstructive sleep apnea.
2. Dental caries, tooth #4, nonrestorable.
OPERATION PERFORMED:
Advancement genioplasty and surgical extraction of tooth #4.
SURGEON: John Doe, DDS
ANESTHESIA: General via oral endotracheal tube.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS: Tooth #4, sent to surgical pathology for gross identification.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed in the supine position. After induction of general anesthesia via an oral endotracheal tube, the patient was prepped and draped in the usual sterile fashion. The patient received preoperative antibiotics and steroids intravenously. Also, approximately 6 mL of lidocaine with 1:100,000 epinephrine was injected around tooth #4 and also infiltrated into the anterior mandibular labial vestibule.
We began with the extraction of tooth #4. A periosteal elevator was used to elevate the mucoperiosteal flaps and a straight elevator and bayonet forceps were used to deliver the tooth. No sutures were placed over the extraction site. The tooth was sent to pathology for gross identification only.
Next, we performed the advancement genioplasty. Monopolar Bovie electrocautery set at 25 cut, 25 coag, was used to make a 5 cm curvilinear incision on the mucosal surface of the lower lip. This was carried down to and through the mentalis muscle and to and through periosteum. Superior and inferior mucoperiosteal flaps were elevated. We took great care to dissect bluntly and identify the mental nerves, first on the left side and then the patient's right side. Great care was taken throughout the procedure to preserve these nerves intact.
Next, a hole was drilled with a small tapered fissure bur in the midline, exactly 25 mm inferior to the incisal edges of the mandibular central incisor teeth. This hole was to mark our midline and the superior and inferior position of our osteotomy cut. Two holes were drilled approximately 5 mm superior and inferior to this hole to also assist with marking the midline. A reciprocating saw was then called for and the osteotomy cut was performed. This cut was in an oblique fashion through the osseous chin, and it was 5 mm inferior to the mental foramen on both sides and through our midline hole that was marked. The chin was then freed up and our usual set of three pairs of drilled holes were placed to advance the chin. Finally, a total of three 24 gauge surgical stainless steel wires were placed through these paired holes and tightened to advance the chin 10 mm. Good bone-to-bone contact was noted on the lingual edge of the distal segment. There was good fixation of the osteotomized segment.
A meticulous layered plastic closure was then performed. Copious amount of irrigation was used to cleanse the wound and 3-0 Vicryl interrupted sutures were used to reapproximate the mentalis muscle and 4-0 chromic gut sutures were used to reapproximate the mucosa. There were no complications during this procedure. The patient appeared to tolerate the procedure well. The sponge and needle count was correct at the end of the procedure.
We began with the extraction of tooth #4. A periosteal elevator was used to elevate the mucoperiosteal flaps and a straight elevator and bayonet forceps were used to deliver the tooth. No sutures were placed over the extraction site. The tooth was sent to pathology for gross identification only.
Next, we performed the advancement genioplasty. Monopolar Bovie electrocautery set at 25 cut, 25 coag, was used to make a 5 cm curvilinear incision on the mucosal surface of the lower lip. This was carried down to and through the mentalis muscle and to and through periosteum. Superior and inferior mucoperiosteal flaps were elevated. We took great care to dissect bluntly and identify the mental nerves, first on the left side and then the patient's right side. Great care was taken throughout the procedure to preserve these nerves intact.
Next, a hole was drilled with a small tapered fissure bur in the midline, exactly 25 mm inferior to the incisal edges of the mandibular central incisor teeth. This hole was to mark our midline and the superior and inferior position of our osteotomy cut. Two holes were drilled approximately 5 mm superior and inferior to this hole to also assist with marking the midline. A reciprocating saw was then called for and the osteotomy cut was performed. This cut was in an oblique fashion through the osseous chin, and it was 5 mm inferior to the mental foramen on both sides and through our midline hole that was marked. The chin was then freed up and our usual set of three pairs of drilled holes were placed to advance the chin. Finally, a total of three 24 gauge surgical stainless steel wires were placed through these paired holes and tightened to advance the chin 10 mm. Good bone-to-bone contact was noted on the lingual edge of the distal segment. There was good fixation of the osteotomized segment.
A meticulous layered plastic closure was then performed. Copious amount of irrigation was used to cleanse the wound and 3-0 Vicryl interrupted sutures were used to reapproximate the mentalis muscle and 4-0 chromic gut sutures were used to reapproximate the mucosa. There were no complications during this procedure. The patient appeared to tolerate the procedure well. The sponge and needle count was correct at the end of the procedure.
