210 GLOSSOPEXY, TONGUE-TO-LIP ADHESION

          (with or without FRENULOPLASTY)

This procedure is done on acutely ill babies with Pierre-Robin Syndrome.

Babies are in the NICU with respiratory difficulties.

See article 210a CPCFJ Glossopexy for Robin 1992


updated January 12, 2013

 

OPERATIVE TIME: 1 hour

USUAL LOCATION(S): Pres Main

FREQUENCY: rare 2-3 per year

ASSISTANT: No

ICD9 CODES:

756.0 PIERRE ROBIN SYNDROME, 141.3 LINGUA FRENULUM

CPT CODE(S):

41510 GLOSSOPEXY, 41520 FRENULOPLASTY

 

ANESTHESIA NOTES

■HI RISK ANESTHESIA

■baby will be transported directly from NICU

■INTUBATION: Regular ET tube, no RAE,

■may consider naso-tracheal intubation

■Dr. C to start IV and sew in tube with 2-0 silk

■Nasal trumpets, 12, 14, 16

■Kefzol IV 25mg/kg

PATIENT POSITION | SETUP

■TABLE IS USUALLY NOT TURNED

■Dr. C to suture tube with 2-0 silk SH, needle holder, scissors

■Rolled terrycloth towel under shoulders

■Large round gel doughnut under head

■Pedi Baer hugger, blanket

TABLE POSITION

Lower foot, close head gap, DO NOT REMOVE HEAD PIECE.

Large round gel donut head rest.

ROOM SETUP

Warm room 72o, warm bed and head rest w/ Baer

Separate mayo stand for video equip

 

EQUIPMENT and SPECIALS

■Light source w/ headlight

■Baer hugger

SPECIALS

None

PREP

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

DRAPING and PACKS

Cleft Palate Custom Pack, Towel Pack

Head sheet (two green towels and a ¾ sheet), ¾ 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

[1] Megadyne 0118a 2½" needle tip, w/ holster

SUCTION

single with 7fr Frazier tip, 10fr NG suction catheter at end

 

SOLUTIONS | IRRIGATION

Kefzol irrigation 500mg/500cc NS, 30cc syringe with 14g angiocath, saline, water

NEEDLES | SYRINGES

[2] 3cc syringe, [1] 30cc syringe,

[4] 30g needle 5/8", [1]12g angiocath

LOCAL ANESTHETIC

Peds mixture: 50/50 - In 3cc syringe with 30g needle x 2

 1% lidocaine w/ epi 1:100,000 + 0.5% Ropivicaine plain

MEDICATIONS

■Kefzol for irrigation

■Bacitracin ointment

210 GLOSSOPEXY, TONGUE-TO-LIP ADHESION

 page 2

 

SETS TO OPEN Dr. C Cleft Lip / Fine Instrument Set

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

Packing forceps, 05 Adson, 03 Adson, Cushings

     SCISSORS

fine, straight tenotomy, curved tenotomy, Iris, Reynolds

     NEEDLE HOLDERS

Webster needle holder, Crile-Wood needle holder

     RETRACTORS | SKIN HOOKS

Weitlannner x 2 – dull and sharp self retaining retractor

     KNIFE | BLADES

[2] 15 BP scalpel blades - HOLD

     OTHER

[3] mosquito clamps for tongue traction suture

 

STERILE SUPPLIES

■[2]marking pens with ruler

■bacitracin ointment

■½" steri-strips for eyes

■non-disposable light handles

■10fr suction catheter

SPONGES

Raytec, 2" Kling for pharyngeal pack,

[3] 3" cotton tip applicators

NON-STERILE SUPPLIES

Pedi Baer hugger, nasal trumpets (sizes 12, 14, 16)

 

 

No

Type

SN

status

SUTURES

[ 2 ]

4-0 Chromic P3

1654

open

 

[ 2 ]

5-0 Chromic P-3

687

open

 

[ 2 ]

3-0 Vicryl SH

J416

 

hold

[ 2 ]

4-0 Vicryl RB-1

J214

 

hold

[ 2 ]

3-0 Ethibond SH

X762

 

hold

[ 2 ]

3-0 Ethibond RB-1

X558

 

hold

[ 3 ]

2-0 Silk SH

K833

open

 

 

 

 

 

 

 

DRAINS

none

DRESSINGS

bacitracin to lips

 

POSTOPERATIVE

Nasal trumpets back in nose

Cut tongue sutures

Remove pharyngeal pack

Call NICU for transport

NOTES

 

 

COMMENTS

 

DATE MODIFIED

Febr 2009, Jan 2013