PREOPERATIVE DIAGNOSIS:
Recurrent epistaxis.
POSTOPERATIVE DIAGNOSIS:
Recurrent epistaxis.
PROCEDURE PERFORMED:
Control of epistaxis, complex, bilateral, with KTP/YAG
laser.
SURGEON: John Doe , MD
ANESTHESIA: General
endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 10 mL.
SPECIMENS: None.
FINDINGS: Multiple
telangiectasias bilaterally on the septum and the floor of the nasal cavity.
These were controlled with KTP/YAG laser.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and
was placed in the supine position on the operating room table. General facemask
anesthesia was given until a deep plane of anesthesia was obtained. At that
point, an endotracheal tube was placed by the anesthesiology service without
difficulty. Afrin-soaked nasal pledgets were then placed in the nares
bilaterally. After allowing time for anesthesia and decongestion, the surgery
began with 0-degree nasal endoscope in the right nasal cavity. There were
several superficial vessels in the anterior-posterior nasal cavity along the
floor. There were also telangiectasias along the septal wall. The KTP/YAG laser
under endoscopic guidance was used at 2 watts for cauterization of these
multiple telangiectasias and small superficial vessels. The right nasal cavity
was then thoroughly irrigated with normal saline and suctioned clear. There was
no evidence of epistaxis. Attention was then turned towards the left nasal
cavity. Again, this was viewed with 0-degree nasal endoscope. This provided
visualization of several small telangiectasias along the septum. There was a
small septal perforation. Anterior septal perforation appeared to be a small
venous lake, approximately 0.5 mm. There were several small superficial vessels
along the floor of the left nasal cavity, bilateral walls. KTP/YAG laser again
was used under endoscopic guidance for cauterization of the multiple
superficial vessels and telangiectasias. This was also used to control to
cauterize the small venous lake anterior to septal perforation. Small area of
granulation tissue along the floor of the nasal cavity was visualized with a
45-degree nasal endoscope and cauterized with KTP/YAG laser. The left nasal
cavity was then thoroughly irrigated with warm normal saline. There was small
evidence of bleeding from the middle turbinate. It was abraded with the
endoscope. This was cauterized with suction Bovie cautery. Again, both nasal
cavities were thoroughly irrigated with warm normal saline and suctioned. There
was no evidence of bleeding. At that point, the procedure was terminated. The
patient was then awoken from general anesthesia, extubated and sent to postanesthesia care unit.
