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T&A

DESCRIPTION:  After a satisfactory level of general endotracheal anesthesia was obtained, the patient was prepped and draped in the usual manner and placed in the Jackson position.  A Crowe-Davis mouth gag was inserted, holding the endotracheal tube securely in position.  The soft palate was retracted with a catheter, and the nasopharynx visualized with a mirror.  A cauterizing adenoid curet was used to remove the main mass of adenoid tissue with electrocautery. Completion of the adenoid removal in the fossa of Rosenmüller was done with ordinary adenoid curets.  Additional hemostasis was undertaken with electrocautery using suction cautery.  The nasopharynx was packed with sponges and attention was turned to the tonsils.  The left tonsil was grasped with a White tenaculum and retracted medially while incisions were made in the anterior and posterior pillars with coagulating cautery. The tonsil was dissected from its fossa with cautery, with hemostasis using cautery as the dissection was carried out.  The right tonsil was removed in a similar manner.  The nasopharyngeal packing was removed and no further bleeding was seen in the nasopharynx.  The site was irrigated with saline and suctioned free of blood and secretions, then the patient was extubated and taken to the recovery room in good condition.


PROCEDURE IN DETAIL:  The patient was brought to the operating room and placed in supine position.  Adequate oral endotracheal anesthesia was obtained.  A Crowe-Davis mouth gag was inserted and the oropharynx was inspected.  She was noted to have markedly enlarged tonsils measuring 4+ in size and kissing in the midline.  These were grasped with Allis clamps, retracted medially
, and dissected from the tonsillar fossae using Bovie cautery dissection.  There was essentially no bleeding noted.  The soft palate was retracted anteriorly and the nasopharynx was inspected.  She was noted to have a moderate-size adenoid pad.  This was removed using adenoid curets.  Bleeding was controlled using tonsil sponges and suction Bovie.  The patient tolerated the procedure well.  The nasopharynx was irrigated with saline.  The tonsillar fossae were injected with 1% Xylocaine and 1:100,000 epinephrine.  Blood loss was approximately 25 cc.


Tonsillectomy

DESCRIPTION:  After a satisfactory level of general endotracheal anesthesia was obtained, the patient was placed in the Rose position
. A Crowe-Davis mouth gag was inserted.  The soft palate was retracted with a Robinson catheter, and the nasopharynx was inspected and found to be normal.  The left tonsil was grasped and retracted medially while coagulating current was used to incise the anterior pillar and to dissect the tonsil from its fossa. Final hemostasis was obtained with further cautery.  The same procedure was done on the right side.  After completion of the procedure, the mouth and pharynx were suctioned free of secretions and blood.  The patient was then taken to recovery in good condition, having tolerated the procedure well.  Blood loss was less than 10 cc. 

Tympanostomy tube

 

DESCRIPTION:  After a satisfactory level of anesthesia was obtained by mask administration, the left ear was cleaned.  An anterior-inferior myringotomy was made, and a small amount of fluid was suctioned from the middle ear space.  The mucosa did not appear to be remarkably abnormal.  A silastic Donaldson tube was placed in the myringotomy.  The same procedure was carried out on the right side.  After the tubes were in place, the patient was allowed to escape the effects of the anesthetic, and was taken to recovery in good condition, having tolerated the procedure well.  No blood loss.

PROCEDURE IN DETAIL:  The patient was brought to the operating room and placed in supine position.  Adequate general anesthesia was obtained.  Under binocular microscopy, the left ear canal was cleaned of ceruminous debris. The tympanic membrane was very opaque and injected.  Anterior-inferior radial myringotomy revealed the middle ear was completely filled with mucopurulent debris which was aspirated.  A tympanostomy tube was placed in the myringotomy site without difficulty.  Under binocular microscopy, the right tympanic membrane was very dull.  Anterior-inferior radial myringotomy revealed thick middle ear mucus which was aspirated.  After this was evacuated, a tympanostomy tube was placed in the myringotomy site without difficulty.  Vasocidin ophthalmic drops were instilled into each ear canal.  The patient tolerated the procedure well.