Surgeon(s): ***

‍Assistant Surgeon(s):  ***

‍Preoperative Diagnosis: ***

‍Postoperative Diagnosis: Same

‍Procedure(s): ***

‍Anesthesia: General

‍Implants: None

‍Specimen:***

‍Drains: None

‍Fluids: See anesthesia record

‍EBL: Minimal

‍Complications: None

‍Counts:  Correct x2

‍Indications: ​***

‍Findings: As expected

‍Procedure in Detail:

‍The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

2% lidocaine w 1:100k epinephrine was injected at the proposed extra oral trochar site. The needle was changed and the intraoral incision site was injected via local infiltration with 10 ml of 2% lidocaine w 1:100k epinephrine. Hybrid arch bars were applied to the maxilla and mandible. The incision site was marked with a marking pen. A Selden and toe in retractors were used to place tension over the incision site. A 15 blade was used to make an incision through the mucosa. Retractors were placed in the incision site. A bovie was used to take the incision down to bone. A subperiosteal dissection was performed using a #9. The fracture site was exposed and derided with curettes and a #9. The fracture was reduced and the pt placed into MMF using 24 gauge wires.

A debakey was used to mark the puncture site of the trochar. The trochar site was introduced and brought to the site of the fracture using a suction tip to guide the trochar through the soft tissues. Next a 6 hole 2.0 mm plate was adapted to the superior border of the reduced angle fracture. The plate was then fixated with a series of monocortical screws under copious normal saline irrigation.

The pt's MMF was released and the occlusion was noted to be stable and reproducible. The surgical site was copiously irrigated with normal saline irrigation. Hemostasis was noted. The surgical site was closed using 3-0 chromic gut in a running fashion. The extraoral site was closed with a sinlgle interrupted 5-0 plain gut suture. Heavy elastics were applied bilaterally.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

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