208 MINOR REVISION CLEFT LIP w/ COMPLEX REPAIR

usually a minor procedure involving the muscosa or vermillion of the lip only

see also 204 Repair Cleft Lip

updated November 10, 2015

 

OPERATIVE TIME: 1 hour

USUAL LOCATION(S): Kaseman

ICD9 CODES:

749.21LIP & PALATE, UNILATERAL, COMPLETE

749.23LIP & PALATE, BILATERAL, COMPLETE

749.11 LIP, UNILATERAL, COMPLETE

CPT CODE(S):

40654REPAIR LIP COMPLEX

 

ANESTHESIA NOTES

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

● Dr. C to start IV

● Kefzol IV 25mg/kg

PATIENT POSITION | SETUP

● NO TURN

● No suture tube

● Rolled terrycloth towel under shoulders

● Large round gel doughnut under head

● Baer hugger, blanket, green towels

TABLE POSITION

NORMAL POSITION

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

Large round gel donut head rest.

Chux diaper

ROOM SETUP

Pre-warm room and bed, Baer to bed

 

EQUIPMENT and SPECIALS

● Light source w/headlight on patients 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

KASEMAN: ENT Pack

PRES MAIN: Cleft Palate Custom Pack, Towel Pack

Head sheet (two green towels and a ½ sheet), ½ sheet, magnetic pad, rigid box for bovie, towel clips, ½” steri-strip for eyes, 1000 drape, 2" Kling for pharyngeal 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

[2] 3cc syringe w/ [2] 30g needle for injection

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

LOCAL ANESTHETIC

1% lidocaine w/ epi 1:100,000

MEDICATIONS

● Kefzol for irrigation

● Bacitracin ointment

208 MINOR REVISION CLEFT LIP

page 2

 

SETS TO OPEN

Dr. C. fine instrument set

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

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

0.5 titanium

     SCISSORS

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

     NEEDLE HOLDERS

Castroviejo, smooth Webster, super-fines

     RETRACTORS | SKIN HOOKS

2, 5, 10mm skin hooks, Ragnell

     KNIFE | BLADES

[1] 15 BP scalpel blades

     OTHER

 

 

STERILE SUPPLIES

■[2] marking pens

■bacitracin ointment

■Telfa pad

SPONGES

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

 

DRAINS

none

DRESSINGS

bacitracin to lip at end

 

POSTOPERATIVE

 

NOTES

 

 

COMMENTS

 

DATES MODIFIED

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

Dec 2014, Nov 2015