208 MINOR REVISION CLEFT LIP w/ COMPLEX REPAIR

A minor procedure involving the muscosa or vermillion of the lip only.

If more than one case is scheduled, will need to open hospital fine facial set.

See also 204 Repair Cleft Lip

updated October 6, 2017

 

OPERATIVE TIME: 30 minutes

USUAL LOCATION(S): Kaseman

CPT CODE(S):

40654REPAIR LIP COMPLEX

 

ANESTHESIA NOTES

● regular ET tube (no RAE) w/ accordion extension to left side

● Dr. C to start IV

● Kefzol IV 25mg/kg

● Tape the eyes

PATIENT POSITION | SETUP

● NO TURN

● No suture tube

● Rolled terrycloth towel under shoulders

● Large round gel doughnut under head

● Baer hugger, blanket

TABLE POSITION

NORMAL POSITION

Lower foot, close head gap, Do Not Remove Head Piece.

Large round gel donut head rest.

ROOM SETUP

Pre-warm room 70°, Baer hugger on OR table.

 

EQUIPMENT and SPECIALS

● Light source w/headlight on patient’s right side

● Baer hugger

SPECIALS

None

PREP

PCMX with minimal water, cotton tip applicators to clean nose, wipe inside mouth, lightly over eyelids

DRAPING and PACKS

at KASEMAN: ENT Pack

at PRES MAIN: Cleft Palate Custom Pack, Towel Pack

4 blue towels, ½ sheet, magnetic pad, bovie holster, towel clips,1000 drape, 2" Kling for throat pack

CAUTERY

Bovie 8/8 pure, Colorado tip

SUCTION

single with 7fr Frazier tip

 

SOLUTIONS | IRRIGATION

Kefzol irrigation 500mg/500cc NS

saline, water

NEEDLES | SYRINGES

[1] 3cc syringe w/ [1] 30g needle for injection

[1] 10cc syringe w/ [1] 18g angiocath - for irrigation

[1] 30 g needle for tattooing - Hold

LOCAL ANESTHETIC

1% lidocaine w/ epi 1:100,000

MEDICATIONS

● Kefzol for irrigation

● Mupirocin ointment tube 22g

● Methylene blue for tattoing - Hold

208 MINOR REVISION CLEFT LIP

page 2

 

SETS TO OPEN

Dr. C. Bleph/fine instrument set

Kaseman fine facial set

Pres Main fine cleft set

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

Packing forceps, 05 Adson, .3 & .5 CV fine

     SCISSORS

Gradle, papa mama baby bears, straight tenotomy, curved tenotomy, Iris

     NEEDLE HOLDERS

[2] Castroviejos, smooth and serrated Websters, super-fines

     RETRACTORS | SKIN HOOKS

2, 5, 10mm skin hooks, Ragnell

     KNIFE | BLADES

[1] 15 BP scalpel blades

     OTHER

 

 

STERILE SUPPLIES

■[2] marking pens

■Mupirocin ointment 22g tube

■Telfa pad

■Methylene blue for tattooing - Hold

SPONGES

10 pac Raytec, 2" Kling for pharyngeal pack,

NON-STERILE SUPPLIES

 

 

 

No

Type

SN

status

SUTURES

link to suture list

 

[ 1 ]

4-0 PDS RB-1

Z304

 

hold

[ 2 ]

5-0 Chromic P-3

687

open

 

[ 2 ]

6-0 Chromic G-1 single

796

open

 

[ 1 ]

5-0 Monocryl TF

Y433

 

hold

[ 1 ]

6-0 Monocryl P-1

Y489

 

hold

[ 1 ]

5-0 Plain Fast Ab PC-1

1915

 

hold

[ 1 ]

6-0 Plain Fast Ab PC-1

1916

 

hold

[ 1 ]

6-0 Prolene P1

8697

 

hold

 

DRAINS

none

DRESSINGS

Mupirocin ointment to lip at end, give remainder to parent

 

POSTOPERATIVE

 

NOTES

 

 

COMMENTS

 

DATES MODIFIED

Jul 2006, Oct 2007, Mar 2008, Jul 2009, Mar 2012, Mar 2014, Jun 2014,

Dec 2014, Nov 2015, Oct 2017