ENT Operative Transcription Samples For Medical Transcriptionists:
OPERATION PERFORMED: Bilateral excision of inferior turbinates.
OPERATION IN DETAIL: The patient came to the operating room and was placed in the supine position on the operating room table. General facemask anesthesia was given. At that point, an endotracheal tube was placed by the anesthesiology service without difficulty. Approximately, 6 mL of 1% lidocaine with 1:100,000 epinephrine was injected in the inferior turbinates bilaterally. Afrin-soaked nasal pledgets were then placed in the naris bilaterally. The patient was then prepped and draped in routine fashion. Using 0-degree nasal endoscope, the Afrin-soaked pledget was removed on the right side. This allowed visualization of the inferior turbinate. The inferior turbinate was infractured. Hemostat was then placed across the base of the inferior turbinate where it attached to the lateral wall of the nasal cavity. Endoscopic scissors were then used to excise the inferior turbinate on the right side followed back to nasopharynx. This was sent for pathology. Suction Bovie cautery was then used for hemostasis. Wound was then sterilely irrigated with normal saline. FloSeal was then placed on to the wound for further hemostasis. Attention was then turned towards the left nasal cavity. The Afrin-soaked nasal pledget was removed. The nasal cavity was visualized with 0-degree nasal endoscope. The left inferior turbinate was infractured. Curved hemostat was then used to clamp across the base of the inferior turbinate. This was then removed. Endoscopic scissors were then used to excise the inferior turbinate on the left back to the nasopharynx. Suction Bovie cautery was used to cauterize the wound. Normal saline was then used to thoroughly irrigate the left nasal cavity. FloSeal was placed on to the wound. At that point, the procedure was completed. The patient was extubated and sent to the postanesthesia care unit in stable condition.
OPERATION PERFORMED: Direct laryngoscopy and flexible bronchoscopy.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in supine position on the operating table. General anesthesia was induced and the patient was ventilated through an already intact tracheostomy tube. Anterior commissure laryngoscope was first utilized. The patient was found to have a large amount of redundant soft tissue but no discrete mass or lesion in the oropharynx or hypopharynx. The large amount of soft tissue included lingual tonsillar hypertrophy, a large amount of postcricoid edema consistent with gastroesophageal reflux disease. True vocal folds showed a mild to moderate amount of Reinke's edema. There was a small amount of resolving ecchymosis along the posterior aspect of the right true vocal fold at the vocal process. No other significant trauma visible to the larynx. Next, the bronchoscope was passed through the patient's oral cavity and through the true vocal folds. The immediate subglottis was visualized along with the entrance of the tracheostomy tube, which was seen to be well positioned within the trachea. There was no visible fixed obstruction at this level. At this point, the #6 extended length Shiley was removed and a #5 uncuffed extended length Shiley was placed into the already intact tracheotomy. Under visualization with the bronchoscope, it was seen to extend well into the trachea with good positioning. The bronchoscope and laryngoscope were then removed. The bronchoscope was then placed through the tracheostomy tube and the trachea was visualized down to the larynx. There seemed to be no tracheomalacia and no masses or lesions down to the level of the carina. The new tracheostomy tube was then secured to the patient's neck and the patient was then awakened and taken to the postanesthesia care unit in stable condition.
OPERATION PERFORMED: Endoscopic Zenker diverticulotomy revision.
OPERATION IN DETAIL: After consent was obtained from the patient, 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 anesthesia was obtained. At that point, an endotracheal tube was placed by the anesthesiology service without difficulty. The table was then turned. The procedure began with placement of a wet 4 x 4 gauze to protect the upper gums. An esophagoscopy was performed for location of the Zenker diverticulotomy. The Zenker was identified. The depth of the Zenker appeared to be less than 2 cm. The esophagoscope was then removed and the Weerda scope was placed in the oral cavity, oropharynx, and hypopharynx to identify the Zenker in esophagus. Prior to placement of the Weerda scope, a flexible nasogastric feeding tube was placed through the nose down to the stomach. The Weerda scope was then positioned and opened. This allowed visualization of the esophagus and the Zenker. The nasogastric tube was visualized to be going down to the esophagus towards the stomach. Decision was then made to perform an endoscopic Zenker diverticulotomy with the Harmonic scalpel. Harmonic scalpel was then used to excise the common party wall between the Zenker diverticulum and the esophagus. The cricopharyngeal muscle was cut completing a full myotomy. The Harmonic scalpel was used to excise the common party wall down to the depth of the diverticulum. No evidence of perforation was noted. The Weerda scope was then removed from the oral cavity and oropharynx without difficulty. There was no injury to the lower teeth. There was no injury to the upper gums. At that point, the procedure was completed. The patient was awoken from general anesthesia, extubated, and sent to the post anesthesia care unit in stable condition.
OPERATION PERFORMED: Right superficial parotidectomy and selective neck dissection.
OPERATION IN DETAIL: The patient came to the operating room and was placed in the supine position on the operating room table. General facemask anesthesia was given until anesthesia was obtained. At that point, endotracheal tube was placed by the anesthesiology service without difficulty. The table was then turned. Approximately 10 mL of 1% lidocaine with 1:100,000 epinephrine was injected around the previous incision site. The patient did have a previous wide margin excision of a malignant melanoma with lymphoscintigraphy. The patient was then prepped and draped in routine fashion. A facial nerve monitor was used throughout the entire case for monitoring the facial nerve. At that point, the electrodes were placed onto the patient and the nerve monitor was tested and was functional. The procedure began by reopening the previous incision. This was a relatively fresh incision, thus the skin edges opened up readily. This allowed visualization of the superficial parotid fascia and the platysma. The subplatysmal plane was then opened medially and laterally. This allowed visualization to the sternocleidomastoid muscle, immediately to the midline of the neck. The fascia overlying the parotid gland was then opened anteriorly to the masseteric muscle. This allowed full visualization. The marginal branch of the mandibular nerve was identified at its distal extent. This was dissected laterally to find the root of the facial nerve. The pes of the facial nerve was then identified. The branches of the facial nerve were then identified and traced distally, starting from the marginal nerve superiorly, up to the frontal branch. The overlying divisions of parotid tissue were removed and unfolded in a superior direction. The parotid resection was then sent for permanent pathology. The nerve stimulator was used throughout the entire superficial parotidectomy to identify the branches of the nerve. After completion of the parotidectomy, the nerve was stimulated at its roots and all of the facial branches were functional. Attention was then turned toward the neck dissection. The posterior digastric was identified in its anterior part. This was followed back to the sternocleidomastoid muscle. The overlying tissues were removed and retracted inferiorly. The facial vein was cross-clamped, cut and tied with 3-0 silk suture. The sternocleidomastoid muscle was then unraveled in routine fashion, down to the level of the superior level of the thyroid cartilage. The eleventh nerve was identified and freed from its surrounding tissue and preserved. The tissue in level IIB of the neck was then dissected free with Bovie cautery and retracted underneath the nerve. The floor of the neck was then dissected with Bovie cautery up to the internal jugular vein. The internal jugular vein was preserved in its entire extent. The tissue overlying the vein was dissected free with snap dissection and Bovie cautery. The remainder of level II of the neck was then freely dissected out with Bovie cautery. This was then sent for permanent pathology. The wound was then thoroughly irrigated with normal saline. Hemostasis was obtained with Bovie cautery. A #10 JP drain was then placed into the wound and secured to the neck skin with 2-0 Prolene stitch. The wound was then closed in layer fashion with 3-0 Vicryl to reapproximate the platysmal muscle and the superficial parotid fascia. The skin edges were reapproximated with 5-0 Prolene. The patient was then awoken from general anesthesia, extubated and sent to the post anesthesia care unit in stable condition.
OPERATION PERFORMED: Bilateral maxillary antrostomy and frontal sinusotomy with balloon dilatation.
OPERATION IN DETAIL: The patient came to the operating room and was placed in supine position on the operating table. General facemask anesthesia was given until anesthesia was obtained. At that point, an endotracheal tube was placed by anesthesiology service without difficulty. Approximately, 7 mL of 1% lidocaine with 1:100,000 epinephrine was injected into the uncinate and middle turbinates bilaterally. Afrin-soaked nasal pledgets were placed into the nasal cavities for further decongestion. The patient was then prepped and draped in routine fashion. The procedure began in the left nasal cavity. The middle turbinate was medialized. This allowed access to the ethmoid bulla and uncinate. The insertion probe was then placed behind, lateral to the uncinate. A wire was passed through the insertion probe. Fluoroscopy confirmed the wire placement of the maxillary sinus. A balloon dilator was placed over the wire catheter. The position of the balloon was confirmed with fluoroscopy. The balloon was then inflated performing the maxillary antrostomy. After the balloon was deflated and removed from the nose, nasal endoscopy revealed excellent dilation of the right maxillary sinus. The endoscope was then placed in the left nasal cavity. Again the middle turbinate was medialized. The ethmoid bulla and uncinate were identified. The insertion probe was placed behind and lateral to the uncinate. The wire was passed through the insertion guide and confirmed in the maxillary sinus with fluoroscopy. The balloon was then placed over the guidewire into the maxillary sinus. Again, the location was identified with the distal tip in the maxillary sinus and proximal tip of the bone and nasal cavity. Balloon dilation was performed. This was confirmed with fluoroscopy. The balloon was then deflated and removed from the nose. Again, 0-degree nasal endoscope was used to visualize the antrostomy, which was large. Attention was then turned towards the left frontal sinus. The left frontal sinus introducer was placed just posterior to the attachment of the middle turbinate and uncinate bone. The wire was passed through the frontal sinus guide. Fluoroscopy was used to identify entrance of the wire into the left frontal sinus. The wound dilator was then placed over the wire, up into the nose and confirmed the location with fluoroscopy. The balloon was then inflated to 12 atmospheres. The fluoroscopy was used to confirm inflation of the balloon. The balloon was then deflated and removed from the nose. A 0-degree nasal endoscope confirmed a large frontal sinusotomy. Attention was then turned towards the right nasal cavity. Again, the introducer was placed behind the middle turbinate were the uncinate connected to the middle turbinate. The guidewire was passed, and under fluoroscopic guidance, the wire was passed from the right frontal sinus. The balloon catheter was then placed over the wire. The position of the balloon was confirmed with fluoroscopy. The balloon was then dilated to 12 atmospheres. The dilation was confirmed with fluoroscopy. The balloon was then deflated and removed from the nose. A 0-degree nasal endoscope was used to confirm the frontal sinusotomy. The wound was then thoroughly irrigated with normal saline. Afrin-soaked nasal pledgets were placed into the area of the surgery. The patient was then awoken from general anesthesia, extubated, and sent to the postanesthesia care unit in stable condition.
OPERATION PERFORMED: Tonsillectomy.
OPERATION IN DETAIL: The patient taken to the operating room and was placed in the supine position on the operating room table. General facemask anesthesia was given until anesthesia was obtained. At this point, an endotracheal tube was placed by the anesthesiology service without difficulty. The table was then turned. The patient was prepped and draped in routine fashion. The Crowe-Davis mouth gag was then inserted carefully to avoid dental injury. The oral cavity and oropharynx were identified. Surgery began with the right tonsil being grasped with an Allis and medialized. Bovie cautery was then used to excise the tonsil from the tonsillar fossa. Small vessels were identified and cauterized. The tonsil was removed and sent for permanent pathology. The Allis clamp was then placed under the left tonsil and medialized. Bovie cautery was then used to excise the tonsil from the tonsillar fossa. Small vessels were identified and cauterized. The tonsil was then removed and sent for permanent pathology. Suction Bovie cautery was used to cauterize superficial vessels which were identified bilaterally. The wound was then thoroughly irrigated with normal saline. There was no further evidence of bleeding. A mirror was then used to visualize the nasopharynx to see if the adenoids needed to be removed. There was very little to no adenoid tissue in the adenoid bed. The wound was then again thoroughly irrigated with normal saline and suctioned. Again, there was no further evidence of bleeding. Orogastric tube was then placed, suctioned the stomach. At that point, the procedure was terminated. The mouth gag was removed. The teeth were checked and were intact. The patient was then awoken from general anesthesia, extubated and sent to the postanesthesia care unit in stable condition.
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